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Postoperative panophthalmitis

Case contributed by Carlos Felipe Hurtado Arias
Diagnosis certain

Presentation

15 days before this ultrasound the patient had a phakectomy and an intraocular lens implant. After three days, the patient noticed purulent discharge through the eye and scarce eyelid edema. A topical antibiotic was used without improvement.

Patient Data

Age: 65 years
Gender: Male
ultrasound

The eyeball is slightly enlarged; also, its contour is irregularly thickened, which is especially evident in the posterior wall. In the posterior chamber, there are multiple echoes of mobile intermediate signal, forming hydro-liquid levels, and echogenic septa of dorsal thicknesses, without vascular flow on Doppler.

The ophthalmic vein has a signal, and its spectral morphology is normal. The spectral analysis of the posterior ciliary arteries documents a monophasic flow with an increased resistance index; a very suggestive finding of ischemic neuritis possibly associated with arterial compression secondary to extensive and severe intraorbital fat edema (continent principle and content).

The fat of the intraorbital fat demonstrates a marked echogenicity and areas where sheets of anemic laminar fluid are observed, without apparent collections.

Absence of the lens, and in its place, an intraocular lens, which has an oblique disposition, partially losing contact with the usual surface; indicative finding of subluxation of the prosthesis.

Case Discussion

This patient is currently in prison, living in non-salubrious conditions and lacking access to high quality healthcare. Status post phakectomy and intraocular lens implant, he presented with a severe postoperative orbital infection.

On examination, chemosis prevented a full evaluation of the eye; also, there was edema, erythema, pain, and an increase in the thermal perception of the skin of the eyelids and adjacent malar and frontal region. There was also purulent secretions and painful eye movements.

He was evaluated by an ophthalmologist, giving him an initial diagnosis of endophthalmitis, hospitalization, initiation of broad-spectrum antibiotics, local anti-inflammatory agents, and requested an ultrasound. 

The ultrasound demonstrated the involvement of the sclera, and therefore it was re-diagnosed as a panophthalmitis. In addition, there were sonographic signs of pre- and post-septal orbital cellulitis.

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