Endogenous Endophthalmitis Associated with Facial Cellulitis After a Tongue Bite

Abstract

Endogenous endophthalmitis is an intraocular infection that results from hematogenous spread of organisms from a distant source of infection. Facial cellulitis is rarely reported as a focus of infection. We report a case of 51-year-old unconscious woman presenting with fever, facial swelling, and decreased visual acuity secondary to facial cellulitis, endogenous endophthalmitis and end-stage renal disease (ESRD). Generally systemic antibiotics in endophthalmitis have low efficacy because of the blood-ocular barrier. The management of endophthalmitis begins with intravitreal antibiotic injections and if the response is not favorable to do a vitrectomy. Twelve hours after the intravitreal antibiotic injection, vitrectomy was considered because of worsening of the vitreal cloudiness. However, the patient's general medical condition precluded vitrectomy. We experienced successful treatment with intravitreal antibiotic injection and continuous intravenous antibiotic administration because of the breakdown of the blood-ocular barrier due to ocular inflammation, especially in the setting of systemic vascular and fluid homeostatic changes.

Endophthalmitis: Experience from a Tertiary Eye Care Center

“…Orbital and peri-orbital cellulitis have been reported as causes of endogenous endophthalmitis. [8,37] Facial cellulitis is rarely reported as a focus of infection leading to endogenous endophthalmitis. Facial cellulitis usually appears more rapidly than other deep infections, so treatment is required early on.…”

“…These anatomical characteristics explain how facial cellulitis can be a primary infection site of endogenous endophthalmitis. Kang et al, [8] reported a case of 51-year-old unconscious woman presenting with fever, facial swelling, and decreased VA secondary to facial cellulitis, endogenous endophthalmitis and end-stage renal disease. These authors reported successful treatment with intra-vitreal (Vancomycin, Ceftazidime) and intravenous antibiotics (Vancomycin, Meropenem).…”

“…Less common causes of endogenous endophthalmitis include orbital and periorbital cellulitis and in rare cases facial cellulitis. [8] Recently, endophthalmitis was a major reason for evisceration among the 187 cases reported from a tertiary eye care center. [9] (a) (b) Figure 1.…”