Microbial keratitis in keratoglobus-associated vernal keratoconjunctivitis and atopic dermatitis.
OBJECTIVE
The authors describe a patient with keratoglobus and a history of vernal keratoconjunctivitis and atopic dermatitis who acutely developed corneal hydrops and severe microbial keratitis. The infectious keratitis responded poorly to medical management and resulted in enucleation of the eye.


METHODS
A 25-year-old man presented with an acutely painful, red left eye. He had an ocular history of keratoglobus in association with vernal keratoconjunctivitis and atopic dermatitis. His visual acuity was light perception in the left eye and 20/40 in the right eye. Ocular examination showed a grossly edematous cornea with breaks in Descemet's membrane, a central infiltrative ulcer, and hypopyon.


RESULTS
Corneal scrapings showed gram-positive beta-hemolytic streptococci, for which topical treatment of ceftazidime and benzylpenicillin every 30 minutes by day and night was commenced with an oral course of ciprofloxacin 750 mg twice a day. Despite aggressive therapy, the microbial keratitis progressed, and the hypopyon increased in size. The patient subsequently underwent enucleation of his left eye.


CONCLUSIONS
This is the first reported case of microbial keratitis with corneal hydrops in a patient with keratoglobus, vernal keratoconjunctivitis, and atopic dermatitis. His ocular and dermatologic comorbidity may have impaired corneal integrity and allowed penetration of organisms, resulting in a severe case of keratitis that responded poorly to medical management.
Nguyen
Dan Q
DQ
Department of Ophthalmology, Musgrove Park Hospital, Taunton, United Kingdom. danqbnguyen@hotmail.com
Sidebottom
Richard
R
Bates
Adrian Keith
AK
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003233:Conjunctivitis, Allergic / Q000150:complications*; D003315:Cornea / Q000002:abnormalities*; D015715:Corneal Edema; D003876:Dermatitis, Atopic / Q000150:complications*; D004359:Drug Therapy, Combination; D005124:Eye Abnormalities / Q000150:complications*; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007634:Keratitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D000890:Anti-Infective Agents