Postoperative endophthalmitis

Case contributed by Dr Carlos Felipe Hurtado Arias

Presentation

15 days before this ultrasound the patient had a phakectomy and implanted an intraocular lens. After three days, the patient noticed purulent discharge through the eye and scarce eyelid edema. A topical antibiotic was used without improvement.

Patient Data

Age: 65 years
Gender: Male
Ultrasound

The eyeball is slightly enlarged; also, its contour is irregularly thickened, which is especially evident in the posterior wall. In the posterior chamber, there are multiple echoes of mobile intermediate signal, forming hydro-liquid levels, and echogenic septa of dorsal thicknesses, but that in no way showed signal in the evaluation with power Doppler or color.

The ophthalmic vein has a signal, and its spectral morphology is normal. The spectral analysis of the posterior ciliary arteries documents a monophasic flow with an increased resistance index; very suggestive finding of ischemic neuritis possibly associated with arterial compression secondary to extensive and severe intraorbital fat edema (continent principle and content).

The fat of the intraorbital fat demonstrates a marked echogenicity and areas where sheets of anemic laminar fluid are observed, without apparent collections.

Absence of the lens, and in its place, an intraocular lens, which has an oblique disposition, partially losing contact with the usual surface; indicative finding of subluxation of the prosthesis.

Case Discussion

The patient, who lives in unhealthy conditions and with poor access to quality medical services, who undergo phakectomy and intraocular implant lens, presented with a severe infectious complication, which is initially considered endophthalmitis, but with ultrasound, it is demonstrated the involvement of the sclera, and therefore it is a panophthalmitis. In addition, they have sonographic signs of pre and post-septal cellulitis.

Taking into account that it is a patient who is serving a sentence in prison, his access to health services is poor. On examination, chemosis prevented a full evaluation of the eye; also, it had edema, erythema, pain, and an increase in the thermal perception of the skin of the eyelids and adjacent malar and frontal region. There was also increased purulent secretion and pain with eye movements. He was evaluated by an ophthalmologist, giving him a diagnosis of endophthalmitis, hospitalization, initiation of broad-spectrum antibiotics, local anti-inflammatory, and requests an ultrasound, on which signs of panophthalmitis were documented.

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Case information

rID: 69132
Published: 3rd Jul 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Radiologos Asociados S.A.S - CEDICAF Pereira

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