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36 year old man with redness, discharge and blurred vision in the left eye
Digital Journal of Ophthalmology 1997
Volume 3, Number 11
January 21, 1997
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Matthew Runde, M.D. | Wills Eye Hospital, Philadelphia, PA
Christopher Rapuano, M.D. | Wills Eye Hospital, Philadelphia, PA
Treatment
The corneal ulcer was vigorously cultured and smears were obtained. Gram stain showed no organisms and no white cells. The patient was started on topical fortified cefazolin (50 mg/ml) and tobramycin (15 mg/ml) drops, to be used every 60 minutes, alternating every half hour. After five days of this therapy, the cultures remained negative and the ulcer was clinically unchanged. A conjunctival swab that had been done previously at the rehabilitation facility revealed a culture positive for methicillin resistant Staphylococcus aureus (MRSA).

The ulcer was re-cultured, this time making an explicit effort to get deeper material FROM within the ulcer. Vancomycin was substituted for the cefazolin every 2 hours around the clock. After six days of this therapy, the patient's vision was finger counting at 2 feet, the ulcer was essentially unchanged in size, and the epithelial defect had enlarged. In addition, there was a hypopyon filling <5% of the anterior chamber.

A corneal biopsy was performed (see Figure 2).

As the ulcer was presumed to be sterile, a lateral tarsorraphy was performed on the left eye. Vigorous lubrication with bacitracin ointment and artificial tears was instituted. The antibiotics were discontinued. To date, the patient remains with significant corneal ulceration and, in fact, has developed similar corneal ulceration in the right eye as well, despite aggressive efforts and a tarsorrhaphy on that eye.
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Figure 2
The pathology report on the tissue revealed no organisms and few white blood cells.