Bacterial keratitis caused by multidrug-resistant strains of Pseudomonas aeruginosa is a therapeutic challenge due to a limited number of active antimicrobials and rapid progression to corneal necrosis and perforation. To report the use of topical colistin and surgical tarsorrhaphy in a case of keratitis caused by extensively drug-resistant Pseudomonas aeruginosa in a patient with severe coronavirus disease-2019 (COVID-19) pneumonia. A 56-year-old male was admitted to the intensive care unit with clinical symptoms of severe COVID-19 pneumonia. During his stay in the unit, he developed rapidly progressive keratitis with Pseudomonas aeruginosa resistant to all drugs except for colistin on culture. Due to incomplete lid closure, a temporary tarsorrhaphy was performed, and a regimen of descending-dose topical colistin was initiated. After five weeks, keratitis resolved completely. Extensively drug-resistant Pseudomonas aeruginosa is an unusual cause of bacterial keratitis. We describe the safe and effective use of topical colistin in a case with severe corneal involvement.

El COVID-19 ocasiona manifestaciones clínicas diversas, las manifestaciones oftalmológicas se presentan como conjuntivitis virales. Luego del ingreso del virus, se producen complejas rutas de respuesta inmunológica. Se hallan receptores para el virus en células de la superficie ocular, con predisposición a infección local. Es probable que luego del ingreso del virus se presente una respuesta limitada de la inflamación ocular, el cual podría estar mediado por el enfoque de privilegio inmune.