The photo shows the left eye of a 79-year-old male who reported for a bandage contact lens fit secondary to recurrent corneal erosion. The patient noted episodic pain and redness of his left eye. He had a significant history of advanced glaucoma and dry eye. The patient was currently using the following in both eyes: Restasis (Allergan) b.i.d., artificial tears 12x/day, and Refresh PM (Allergan) q.h.s.
A previous amniotic membrane treatment OS had not been successful in resolving a persistent epithelial defect. His previous best-corrected visual acuity (BCVA) OS was count fingers at two feet. His left eye also had previous argon laser trabeculoplasty (ALT), cataract surgery, and a trabeculectomy. Systemically, the patient was managed for rheumatoid arthritis, polycythemia vera, thyroid disease, and hypertension.
The patient’s entering visual acuity was OS hand motion. Slit lamp examination showed 3+ conjunctival injection, a central infiltrative ulceration, and hypopyon. He was immediately referred to a corneal specialist and cultured.
The patient was prescribed vancomycin and tobramycin drops to be used q1h while awake. Cultures showed no growth after five days, and the patient continued to improve. He was tapered off of his antibiotic drops and prescribed bacitracin ointment.
A persistent epithelial defect remained after resolution of the infection. The patient was referred for a partial lateral tarsorrhaphy, and his condition has stabilized.