Stromal abscess caused by Enterococcus fecalis : An unusual presentation

A Rare Case of Enterococcus faecalis Keratitis in a Neurotrophic Cornea Successfully Treated With Topical Antibiotics and Amniotic Membrane

“…Enterococcus faecalis keratitis is an exceedingly rare occurrence, documented in only a number of cases prior to this report [ 1 , 6 - 11 ]. The typical source of this infection involves post-operative complications, often following keratoplasties [ 7 , 8 ] or as a result of ocular surgery-associated factors [ 1 ].…”

“…Treating Enterococcus faecalis however presents considerable challenges. In vitro antibiotic sensitivity testing may not align with the clinical in vivo response to antimicrobials [ 6 ]. Although vancomycin is a common choice for sensitivity, its usage is limited by factors such as ocular toxicity and poor patient compliance [ 6 , 8 , 9 , 11 ].…”

“…In vitro antibiotic sensitivity testing may not align with the clinical in vivo response to antimicrobials [ 6 ]. Although vancomycin is a common choice for sensitivity, its usage is limited by factors such as ocular toxicity and poor patient compliance [ 6 , 8 , 9 , 11 ]. Additionally, the scarcity of topical vancomycin in the UK, compounded by its off-label use, introduces delays in treatment initiation.…”

“…While Enterococcus-induced ocular infections are rare, they have been reported in conditions such as post-cataract extraction endophthalmitis [2][3][4], conjunctivitis, and orbital cellulitis [5]. Enterococcus faecalis keratitis is an exceptionally uncommon infection, with previously reported cases shown in the Appendices [1,[6][7][8][9][10][11]. Predominantly affecting females, Enterococcus-related keratitis is often linked to ocular surface diseases, corneal graft history, contact lens wearing, and steroid use [11].…”

“…This infection poses a clinical challenge due to its potential virulence, including reported cases of perforation at presentation, and the multi-antibiotic resistance of Enterococcus [ 11 ]. Although vancomycin is often effective, its unavailability for keratitis management, resistance, and potential epithelial toxicity present additional hurdles [ 6 , 9 , 11 , 12 ]. This study aims to contribute by reporting a case of Enterococcus faecalis keratitis in the background of moderate neurotrophia, shedding light on the associated clinical challenges.…”