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Beware contact lens misuse

机译：当心隐形眼镜的误用

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FROM BAD TO WORSEUpon presentation to our clinic, the patient had light perception vision in the right eye, with a completely white opaque cornea. Inferiorly, there was an area of significant thinning but was Seidel negative (Figure 1). As there was no view posteriorly, we performed a B-scan ultrasound, which showed a normal posterior segment. His left eye was normal with 20/20 vision. Cultures were taken and the patient was started on fortified vancomycin 25 mg/ml and tobramycin 15 mg/ml every hour around the clock.Figure 1. External photograph of the cornea at time of presentation.Over the next few days he was watched closely. His cultures returned positive for pan-sensitive pseudomonas. Unfortunately, his thinning progressed, and at his one-week follow-up, his cornea had a perforation in the area of previous thinning. The patient underwent an in-clinic corneal gluing; it was noted that his chamber was flat and he had a white cataract. His glue was holding temporally, but his nasal cornea had also thinned with a new perforation that was plugged by iris (Figure 2). At this point, we discussed the timing and need for a penetrating keratoplasty. As his cornea was still Seidel negative and his eye still acutely infected, we decided to delay the procedure until after the eye was quieter.Figure 2. External photograph of cornea at two-week follow-up visit. Temporal (right side of image) corneal glue is present, progressive thinning and plugged perforation noted nasally.By week three, his cornea had reperforated and was Seidel positive, requiring a second corneal gluing; additionally, his pain increased. A repeat B-scan ultrasound showed increased vitreous opacities; he was subsequently seen by a retina specialist and diagnosed with endophthalmitis. The consulting retina physician performed a tap-and-inject with moxifloxacin and ceftazidime. The tap was culture negative.
机译：从坏到差错提示到我们的诊所，该患者的右眼有轻度的视觉视野，并带有完全白色的不透明角膜。下方有一个明显变薄的区域，但Seidel呈阴性（图1）。由于后方无视野，我们进行了B超检查，结果显示后方节段正常。视力为20/20时，左眼正常。进行培养，患者全天候每小时服用25 mg / ml的加强型万古霉素和15 mg / ml的妥布霉素。图1.出现时角膜的外部照片。在接下来的几天里，他受到密切关注。对于泛敏感的假单胞菌，他的文化恢复了积极。不幸的是，他的变薄进展了，在一周的随访中，他的角膜在先前变薄的区域出现了穿孔。患者进行了诊所内角膜粘连;有人指出他的房间平坦，白内障。他的胶水暂时固着，但是他的鼻角膜也变薄了，新的穿孔被虹膜堵塞了（图2）。在这一点上，我们讨论了穿透性角膜移植术的时机和需求。由于他的角膜仍为Seidel阴性，并且他的眼睛仍被严重感染，因此我们决定将手术时间推迟到眼睛变得更安静之后。图2.随访两周后的角膜外部照片。存在颞角（图像的右侧）角膜胶，逐渐出现变薄和鼻孔穿孔。第三周，他的角膜已经穿孔，并且Seidel呈阳性，需要再次进行角膜粘连;此外，他的疼痛加剧。重复B超检查显示玻璃体混浊增加;随后，他被一名视网膜专家诊治并诊断为眼内炎。咨询的视网膜医生对莫西沙星和头孢他啶进行了轻按一下。水龙头对文化不利。

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