Conjunctivitis progressing into endophthalmitis in an eye with an old scleral buckle and its managements

Abstract

Conjunctivitis is a common eye infection but can be sight-threatening in patients with previous sclera buckles. A 73-year-old man who had right eye scleral buckle surgery two decades ago presented with right eye acute conjunctivitis, for which a topical antibiotic was prescribed. The right eye vision was 6/18, the conjunctiva was not chemosed, the anterior chamber remained quiet, and the fundus was unremarkable. A week later, he returned complaining of right eye painful and blurring of vision. The right eye vision had deteriorated to hand movements. Examination showed right lid swelling, chemosed conjunctiva, exposed scleral buckle, anterior chamber cells, and dense vitritis. These clinical features were suggestive of right eye endophthalmitis. Emergency intravitreal injections, early scleral buckle removal, and vitrectomy with silicone oil tamponade were performed. The patient was also treated with intravenous and topical antibiotics. The final right eye vision was preserved to 6/18. Simple conjunctivitis can progress into endophthalmitis in a patient with a scleral buckle. Prompt surgical management gives the best outcome.