A painful red eye in an intravenous drug abuser: When not everything is what it seems.

INTRODUCTION: Endogenous endophthalmitis is a rare but devastating ocular infection, resulting from microbial seeding of the eye during bacteremia or fungemia. Among other sources of septicemia, intravenous drug abuse is a significant risk factor, and endogenous endophthalmitis should always be thought of in any patient with a history of injectable drug use, presenting with a painful vision loss and a red inflamed eye. CASE DESCRIPTION: We report the case of a 47-year-old male, with a history of injectable drug consumption, who presented to our emergency department complaining of a painful red eye and recent deterioration of visual acuity. After the first clinical hypothesis of endogenous endophthalmitis being considered, the final diagnosis of Human Leukocyte Antigen (HLA) B27-associated acute anterior uveitis was established. CONCLUSION: Ocular inflammation is one of the most challenging fields in all ophthalmology. Several inflammatory disorders, ranging from a wide variety of infectious and non-infectious conditions, can present themselves with the same clinical signs and symptoms, making their diagnosis extremely defiant.

Prone Positioning Covid-19 Patients: A Double-Edged Sword-A Case Report of a Devastating Ocular Complication.

In the late 1970s, prone positioning was established as an efficient treatment for acute respiratory distress syndrome (ARDS). Currently, with the world facing a global health crisis due to the COVID-19 pandemic, it has become an accepted routine practice in intensive care units dealing with critically ill COVID-19 patients. Ophthalmic complications associated with the prone position are not a novelty in clinical practice. Indeed, it is estimated that in patients undergoing spine surgery, prone positioning carries a tenfold increased risk of eye injury when compared to supine and lateral positioning. The majority of these complications are treatable ocular surface disorders, but irreversible sight-threatening conditions also occur. We report a unique and dramatic case of a ruptured globe in a COVID-19 patient placed in prolonged prone position, emphasizing its difficult diagnosis and management while focusing on life-saving support.

Beauveria bassiana keratitis in bullous keratopathy: antifungal sensitivity testing and management.

PURPOSE: Beauveria bassiana is a ubiquitous fungus available as an insecticide. In humans, it has limited virulence; to our knowledge, only 3 cases of invasive disease and 10 cases of keratitis have been documented. METHODS AND RESULTS: We report the first case of B bassiana keratitis in a patient with aphakic bullous keratopathy. The fungal keratitis proved to be highly resistant to topical clotrimazole. Molecular identification was based on DNA sequence analysis. The minimal inhibitory concentrations (MIC) obtained were 2 µg/mL for voriconazole, 0.250 µg/mL for posaconazole, and >128 µg/mL for fluconazole; amphotericin B MIC was >16 µg/mL. In the absence of clinical improvement, a penetrating keratoplasty (PK) was performed. The patient was discharged on topical and systemic voriconazole and prednisolone 40 mg PO/day. The eye remained calm with a transparent cornea and clear anterior chamber. CONCLUSIONS: B bassiana keratitis is extremely rare, with only a few cases reported. Its risk factors are unknown. We report the first case in a patient with aphakic bullous keratopathy, which proved highly resistant to antifungal therapy (antifungal susceptibility results are presented). A PK was necessary for clinical improvement. A review of the literature is performed in an effort to define therapeutic strategies.

Characteristics of open-globe injuries in northwestern Portugal.

PURPOSE: We aimed to characterize epidemiologically open-globe injuries and patterns of posttraumatic endophthalmitis in northwestern Portugal. METHODS: A retrospective review of 163 inpatients with a diagnosis of traumatic open-globe injury treated at the ophthalmology department of the hospital S. João was performed. RESULTS: No cases were reported in patients wearing proper eye protection. Of the 163 eyes, 76.0% were from male patients. The mean age of the males was significantly lower than that of the females (35.6 vs. 56.0 years; p < 0.001), and 57.1% of the cases resulted from personal accidents. The prevalence of intraocular foreign bodies (IOFBs) was 29.6%; IOFBs are more frequent at work (50%) and with metallic objects (50%). The endophthalmitis incidence was 5.7% with a trend for a higher risk with IOFBs. Laceration due to plants increased this risk. CONCLUSIONS: Personal accidents are the most important cause of open-globe injuries. Special relevance should be given to prevention with appropriate eyewear in home chores. Work-related trauma is more associated with IOFB; imaging is fundamental in emergency department evaluation.