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Case Reports: Rare disease
Sterile endogenous panophthalmitis with uncontrolled diabetes
  1. Matthew Azzopardi1,
  2. Benjamin Ng2 and
  3. Yu Jeat Chong3
  1. 1Ophthalmology Department, Royal London Hospital, Barts Health NHS Trust, London, UK
  2. 2Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
  3. 3Inflammatory Eye Disease Unit, Birmingham and Midland Eye Centre, Birmingham, UK
  1. Correspondence to Dr Matthew Azzopardi; matthew.azzopardi{at}nhs.net

Abstract

A female patient with type 2 diabetes in her 50s presented to casualty with a 1-day history of red, painful right eye. Visual acuity (VA) bilaterally was 6/12, but a right anterior uveitis was noted, with hazy fundal view. She was discharged on topical steroid and mydriatic drops with a 2-day follow-up. VA remained unchanged, but she developed right proptosis, restricted eye movements, lid swelling, relative afferent pupillary defect and an intraocular pressure (IOP) of 39 mm Hg. She was admitted and treated with intravenous and intravitreal antibiotics, intravenous antifungals and IOP-lowering drugs. Blood tests showed raised inflammatory markers and an HbA1c of 127 mmol/mol. Over her admission, right eye vision deteriorated to no light perception. A B-scan ultrasound revealed panophthalmitis and a retinal abscess. All investigations looking for a source were negative. Inflammatory markers settled, but despite aggressive treatment, the panophthalmitis did not improve. She was discharged with a follow-up to consider enucleation.

  • Ophthalmology
  • Medical management

http://dx.doi.org/10.1136/bcr-2022-252875

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    Footnotes

    • Twitter @MAzzopardi_

    • Contributors MA and YJC were involved in the direct clinical care of the patient. MA and BN were responsible for drafting the manuscript and conducting the literature search. YJC was responsible for the critical review of manuscript. All authors were involved in the submission process and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.