title: Subconjunctival injections and povidone-iodine washings for the treatment of giant fornix syndrome.
abstract: OBJECTIVE
  Giant fornix syndrome is a chronic copiously purulent conjunctivitis seen in elderly patients with dehiscence of the levator palpebrae superioris aponeurosis. We report a case of giant fornix syndrome secondary to methicillin-resistant Staphylococcus aureus conjunctivitis that was recalcitrant to standard treatment modalities, and we describe 2 novel interventions for this condition, which succeeded in eradicating the infection.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  After failing an aggressive treatment course of topical antibiotics and corticosteroids and after demonstrating an inability to tolerate oral antibiotics, the patient was treated with supratarsal subconjunctival injections of vancomycin and triamcinolone, followed by repeated sweepings of the conjunctival fornices with 10% povidone-iodine on a cotton swab. The patient's symptoms improved dramatically after the antibiotic and corticosteroid injections and ultimately resolved completely after multiple povidone-iodine sweepings.
  
  
  CONCLUSIONS
  In patients with giant fornix syndrome who are recalcitrant to or intolerant of aggressive topical and systemic therapy, supratarsal subconjunctival injections of antibiotics and corticosteroids and sweeping of the conjunctival fornices with povidone-iodine are 2 local treatments which may be useful in eradicating the infection.
authors.affiliation: Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Taylor
authors.forename: Robert E
authors.initials: RE
authors.lastname: Fintelmann
authors.forename: Bennie H
authors.initials: BH
authors.lastname: Jeng
mesh_terms: D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002908:Chronic Disease; D003228:Conjunctiva; D003231:Conjunctivitis / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D011206:Povidone-Iodine / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013577:Syndrome; D007507:Therapeutic Irrigation; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000891:Anti-Infective Agents, Local; D005938:Glucocorticoids; D014640:Vancomycin; D011206:Povidone-Iodine; D014222:Triamcinolone Acetonide