Search

Introduction: This report describes a case of necrotizing scleritis caused by Pseudomonas aeruginosa infection soon after vitreous surgery, which caused severe scleral melting and rapidly progressive necrosis that led to scleral perforation and bacterial endophthalmitis. Case Presentation: The patient was an 86-year-old man with a history of type 2 diabetes mellitus who underwent pars plana vitrectomy (PPV) for vitreous hemorrhage in his right eye. On postoperative day 10, he complained of severe ocular pain and was found to have conjunctival edema and eyelid swelling, which was treated by topical and general systemic antibiotics. His ocular symptoms improved but subsequently worsened. On postoperative day 25, hypopyon and a fibrinous exudative membrane were observed in the anterior chamber, and the fundus could not be visualized. PPV was repeated with addition of silicone oil tamponade. During the surgery, the retina was found to be completely detached with severe anterior scleral melting, perforation, and necrosis, as well as abscess formation. Culture of an eye discharge specimen detected P. aeruginosa. After surgery, antibiotics were administered and the eye was washed with polyvinyl alcohol-iodine solution daily. Ten days later, the eye pain and eyelid swelling were significantly improved. The scleral inflammation gradually resolved without recurrence. Conclusion: In this case, rapidly progressive necrotizing scleritis caused by P. aeruginosa infection was controlled by a combination of antibiotics, removal of necrotic tissue, and daily eye washing with polyvinyl alcohol-iodine solution.

Purpose: To report a case of neurotrophic keratopathy associated with nasopharyngeal carcinoma. Case Report: A 59-year-old man who had been diagnosed with a nasopharyngeal carcinoma was referred to the authors because of visual disturbance and pain in his right eye. Slit-lamp examination revealed a corneal epithelial defect and corneal stromal edema surrounding the epithelial defect area in his right eye. Magnetic resonance imaging showed a mass in his cavernous sinus, which was identified as nasopharyngeal carcinoma (NPC). We diagnosed neurotrophic keratopathy associated with NPC and initiated treatment with preservative-free artificial tears, antibiotic eye drops, fibronectin, a therapeutic contact lens, and amniotic membrane transplantation. However, the persistent corneal epithelial defect was unresponsive to these treatments. Conclusion: Neurotrophic keratopathy secondary to NPC is thought to be rare. We presented a case of neurotrophic keratopathy associated with cavernous sinus metastasis of an NPC. The development of new and more effective treatments for this refractory disease is anticipated.