Can You Guess February's Mystery Condition?
Make your diagnosis in the comments, and look for the answer in next month’s Blink.
Last Month’s Blink
Written and photographed by Zeba A. Syed, MD, Wills Eye Hospital, Philadelphia.
A 73-year-old man presented with two weeks of pain in his left eye, which had not improved on topical antibiotics. He had a past ocular history of pterygium surgery in both eyes about five years ago, and mitomycin-C (MMC) was used intraoperatively during the surgery.
Best-corrected visual acuity was 20/400 in the left eye. Slit-lamp examination revealed a large area of scleral thinning and necrosis nasally. The patient was admitted for broad-spectrum IV and topical antibiotics. Cultures were performed, which grew Pseudomonas. The patient was taken to the operating room one day after admission for surgical debridement, patch grafting using Amnio-Guard (Biotissue), and multilayered amniotic membrane transplantation. He was continued on oral and topical antibiotics, and the infection resolved over the coming weeks.
Less than 10% of cases of scleritis are due to an infection, and Pseudomonas is the most common infectious etiology.1 One risk factor for this condition is prior pterygium surgery, especially with excessive cautery or use of MMC.
1 Ramenaden ER, Raiji VR. Clin Ophthalmol. 2013;7:2113-2122.
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