Endophthalmitis following globe perforation with a hypodermic needle

Abstract

Endophthalmitis following globe perforation with a hypodermic needle EDITOR,-Exogenous endophthalmitis is a common complication of intraocular foreign bodies (IOFBs). 1 It commonly occurs in association with a non-metallic foreign body and often results in profound visual loss. 2 Early diagnosis and treatment with intravitreal antibiotics are essential in its treatment. 3 We describe an unusual case of exogenous endophthalmitis caused by a heroin filled needle, the patient rapidly losing vision despite active intervention. CASE REPORTA 24 year old remand prisoner presented to the casualty department with a vague 2 day history of visual loss in his right eye. He had been stabbed in the eye 2 days previously with a hypodermic needle, which had recently been used for heroin injections.The patient had a visual acuity of hand movement vision in the aVected eye, which was inflamed and had a fibrinoid uveitis. A 3 mm hypopyon was present but a puncture wound was not visible. No fundus view was present. A high reflectivity shadow was seen in the vitreous on B scan ultrasonography ( Fig 1A) and an intraocular hypodermic needle was confirmed on plain x ray ( Fig 1B).The patient underwent a vitreous biopsy and intravitreal ceftazidine 2 mg/0.1 ml, vancomycin 2 mg/ml, and amphotericin B 0.005 mg/ml. The following day, a three port pars plana vitrectomy was performed. Postoperatively, the retina was observed to be detached with two giant retinal tears, one temporally and one nasally. Widespread periphlebitis and retinal necrosis was noted (Fig 2). The broken hypodermic needle was recovered and removed through a corneal incision. Retinal detachment repair was undertaken with heavy liquids, silicone oil, and endolaser photocoagulation. Postoperatively, he was treated with intravenous ciprofloxacin 750 mg twice daily, chloramphenicol eyedrops 1 ⁄2 hourly, atropine eyedrops 1% twice daily, Pred Forte eyedrops (Allergan) 1 ⁄2 hourly, and 40 mg prednisolone orally.The endophthalmitis settled slowly postoperatively, the retina remained flat but vision was reduced to perception of light. The vitreous biopsy grew Streptococcus oralis which was sensitive to chloramphenicol. COMMENTPenetrating eye injuries predominantly occur in young males, and are a common cause of monocular visual loss. 4 5 Endophthalmitis occurs in around 15% of patients with intraocular foreign bodies, the commonest organisms being Staphylococcus epidermidis (23.4%) and mixed organisms (17.3%). The visual prognosis is particularly poor with concurrent infection, 82.3% of patients having no perception of light.The timing of surgery remains contentious. Many authors recommend vitrectomy within 14 days of presentation, particularly if there is retinal detachment. The advantage of intervening before proliferative vitreoretinopathy has develops usually outweighs the universal risk of intraoperative haemorrhage in a recently traumatised globe. In our case endophthalmitis and sight loss developed as a result of Streptococcus oralis contaminated hypodermic needle, whic...

Lens reabsorption following self-induced needling and subsequent intracapsular secondary intraocular lens placement

“…Only 1 case report describes a patient experiencing injury from a needle previously used to inject heroin. 7 The patient was documented to have experienced endophthalmitis and retinal necrosis as a result of the heroin toxicity. Despite using a contaminated needle to injure his eye, our patient did not experience culture-proven endophthalmitis and had no evidence of retinal necrosis.…”

Self-induced Elizabethkingia meningoseptica endophthalmitis: a case report

“…Self-inflicted eye injuries as a cause of visual loss are an unusual, but important, form of self-mutilation [ 3 , 4 ]. They have been associated with a variety of psychological disorders, including paranoid schizophrenia [ 5 - 7 ], drug-induced psychosis, obsessive-compulsive disorder [ 7 ], depression, mental retardation [ 6 ] and ritualistic behavior [ 8 - 10 ] and organic illnesses [ 8 ], including neurosyphilis [ 11 ], Lesch-Nynan syndrome [ 12 ], and following organic brain injury [ 13 ]. Needle perforation is an uncommon form of self-mutilation.…”

“…Soylu et al . reported a non-self-inflicted perforation frequency of 8.3% in one pediatric population, with no figures pertaining to the adult population [ 12 ].…”