Infectious keratitis is a frequent corneal pathology in the ophthalmology emergency services. In most of the cases, an epithelial defect makes infection more accessible for germs. The microorganisms that are most frequently accountable for these clinical diagnoses are pseudomones and staphylococcus; and in the developing countries, the most frequent cause is streptococcus. A male patient went to the emergency room with pain, reddening and decrease of visual acuity after an evolution of one week. He previously visited his General Practitioner, who diagnosed acute conjunctivitis, and prescribed tobramycin and dexamethasone. He had neither a systemic history of relevance nor allergy to drugs. He had undergone cataract surgery in both eyes 4 years before. In the examination carried out in the emergency room he showed a visual acuity in the right eye of 0.16, which improved with pinhole by 0.2, and of 0.9 in the left eye. The bio-microscopy of the former segment showed a moderate ciliary hyperaemia, more intense in the superior temporal quadrant, a white corneal lesion, infiltrated with a perilesional oedema measuring 4x4.5mm, remains of nylon suture and corneal thinning of 70%. It showed a good anterior chamber and scored a 4+ Tyndall effect. (fig. 1)

Samples were taken by means of the corneal abscess scrape for their culture in agar, blood, chocolate agar, Sabouraud agar and thioglycolate. Suture remains removed from the abscess and the conjunctival exudate were also grown in thioglycolate culture. © Distributed under the terms of the Creative Commons Attribution 3.0 License This article is available from: http://archivesofmedicine.com iMedPub JOURNALS ARCHIVES OF MEDICINE | 2009 | Vol. 1 | No. 1:3 | doi: 10.3823/031 Figure 2.

Hipopion for 48 hours starting treatment While waiting for the culture results, the provisional patient’s diagnosis yielded a corneal abscess secondary to corneal suture without classification. A treatment with eyedrops based on reinforced Vancomycin (50mg/ml), and on Ceftazidime (50mg/ml) was immediately started and was alternated every hour without interruption at night for the first day; and then, cyclopegic eyedrops every eight hours were prescribed. The patient kept having an intense pain, without signs of improvement and hypopyon occurred within the following 48 hours. In view of the worsening of the condition, it was agreed to add oral and external-use Voriconazole to the treatment at the suspicion of facing a mycotic onset (fig. 2).