Abstract
Purpose To review the clinical presentation, treatment and outcome in four cases of severe anterior segment infection by Pseudomonas aeruginosa unrelated to contact lens wear.
Methods Four cases presenting over an 18 month period were reviewed.
Results The cases had variable presenting features and outcomes. Complications such as persistent infection, corneal thinning and phthisis bulbi were noted. Possible factors influencing adherence and tissue disruption are discussed.
Conclusions Suspicion of infection by P. aeruginosa and prompt isolation of the organism is needed early in the course of disease. Intensive and prolonged treatment with parenteral and topical antibiotics combined with judicious use of topical steroid gives the best chance of a favourable outcome.
Similar content being viewed by others
Article PDF
References
Helm CJ, Holland GN, Robert G, et al. Combination intravenous ceftazidime and aminoglycosides in the treatment of pseudomonal scleritis. Ophthalmology 1997;104:838–43.
Lotti R, Dart JKG . Cataract as a complication of severe microbial keratitis. Eye 1992;6:400–3.
Moriarty AP, Crawford GJ, McAllaster IL, Constable IJ . Severe corneoscleral infection: a complication of beta irradiation scleral necrosis following pterygium excision. Arch Ophthalmol 1993;111:947–51.
Rubifleld RS, Pfister RR, Stein RM, et al. Serious complications of topical mitomycin-C after pterygium removal. Ophthalmology 1992;99:1647–54.
Hsiao CH, Chen JY, Haung SCM, Ma HK, Chen PYF, Tsai RJF . Intrascleral dissemination of infectious scleritis following pterygium excision. Br J Ophthalmol 1998;82:29–34.
Schein OD, Wasson PJ . Microbial keratitis associates with contaminated ocular medications. Am J Ophthalmol 1988;105:361–5.
Alfonso E, Kenyon KR, Ormerod LD, et al. Pseudomonas corneoscleritis. Am J Ophthalmol 1987;103:90–8.
Schein OD, Hibbard PL, Starck T, Baker AS, et al. Microbial contamination of in-use ocular medications. Arch Ophthalmol 1992;110:82–5.
Pepose JS, Holland GN, Wilhelmus KR . Ocular infection and immunity. St Louis: Mosby, 1996:202–5.
Lochater-Khoranzo D, Gutierrez D . The bacterial flora of the healthy eye. In: Microbiology of the eye. St Louis: Mosby-Year Book, 1977:14–7.
Allison JS, Dawson M, Drake D, Montie TC . Electrophoretic separation and molecular weight characterisation of Pseudomonas aeruginosa H-antigen flagellin. Infect Immun 1985;49:770–4.
Davis DG, Parsek RM, Pearson JP, Iglewiski BH, Costerton JW, Greenberg P . The involvement of cell to cell signals in the development of bacterial biofilms. Science 1998;280:295–8.
McLaughlin-Borlace L, Stapleton F, Matheson M, Dark JK . Bacterial biofilm on contact lenses and storage cases in wearers with microbial keratitis. J Appl Microbiol 1998;84:827–38.
Dua HS . Bacterial keratitis in the critically ill and comatose patient. Lancet 1998;351:387–8.
Masinick SA, Montgomery CP, Montgomery pc, Hazlett LD . Secretory IgA inhibits Pseudomonas aeruginosa binding to cornea and protects against keratitis. Invest Ophthalmol Vis Sci 1997;38:910–8.
McClellan KA . Mucosal defence of the outer eye. Surv Ophthalmol 1997;42:233–46.
Ramphal R, McNiece MT, Polack FM . Adherence of Pseudomonas aeruginosa to the injured cornea: a step in the pathogenesis of corneal infections. Ann Ophthalmol 1981;13:421–5.
Gupta SK, Masinik SA, Hobden JA, Berk RS, Hazlett LD . Bacterial proteases and adherence of Pseudomonas aeruginosa to mouse cornea. Exp Eye Res 1996;62:641–50.
Engel L, Hill JM, Moreau JM, Green LC, et al. Protease IV produces corneal damage and contributes to bacterial virulence. Invest Ophthalmol Vis Sci 1998;39:662–5.
Steuhl KP, Doring G, Thiel HJ . Relevance of host derived and bacterial factors in Pseudomonas aeruginosa corneal infections. Invest Ophthalmol Vis Sci 1987;28:1559–68.
Kernacki A, Goebal MS, Hazlett P, Hazlett LD . Early TIMP gene expression after corneal infection with Pseudomonas aeruginosa. Invest Ophthalmol Vis Sci 1998;39:331–5.
Gachon A-MF, Lacazette E . Tear lipocalin and the eye's front line of defence. Br J Ophthalmol 1998;32:453–5.
Harben T . Recurrence of corneal Pseudomonas infection after topical steroid therapy: report of a case. Am J Ophthalmol 1964;58:670–4.
The Ofloxacin Study Group. Ofloxacin monotherapy for the primary treatment of microbial keratitis: a double-masked, randomised, controlled trial with conventional dual therapy. Ophthalmology 1997;104:1902–9.
Celebi S, Ay S, Aykan U, Bulut V, Alagoz G, Celiker UO . Penetration of oral and topical ciprofloxacin into human aqueous humor. Acta Ophthalmol Scand 1998;76:683–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Radford, R., Brahma, A., Armstrong, M. et al. Severe sclerokeratitis due to Pseudomonas aeruginosa in non-contact-lens wearers. Eye 14, 3–7 (2000). https://doi.org/10.1038/eye.2000.2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/eye.2000.2