A case of pseudemonal keratitis in a 63% TBSA burn

Dr Henry Shepherd1, Dr Andrew Turner1, Dr Aruna Wijewardana1, Dr John Vandervord1, Dr Jeon Cha1

1Royal North Shore Hospital

Bacterial keratitis is a rare but serious medical condition that carries a significant risk of permanent vision reduction or loss. A variety of bacteria have been isolated from patients with keratitis and it is postulated that these derive from local environmental sources. Predisposing factors include extended use of contact lenses, ocular surgical procedures, ocular disease and ocular injury. To our knowledge there has been no reported instance of bacterial keratitis developing after burns to the face.

We report a case of a 26-year-old male who developed pseudemonal keratitis during an acute burn admission following a house fire in 2011. The patient sustained full thickness facial burns as part of an injury totalling 63% total body surface area. During the admission he developed pseudemonal septicaemia and was noted to have new onset bilateral corneal opacifications and purulent ocular discharge on day 8. A diagnosis of severe fulminant bacterial keratitis was made and pseudomonas aeruginosa was grown from corneal scrapings. His visual acuity slowly improved with antimicrobials however he later developed exposure keratopathy secondary to cicatricial retraction from the burn. This was initially managed with splints however 18 months later he required bilateral ectropion release and eyelid grafting. On review 6 years post-burn his visual acuity had improved to 6/9 bilaterally and he complained of only mild ongoing discomfort.

Although rare, this case demonstrates the potentially severe and multifaceted nature of ocular sequelae resulting from facial burns.

Henry is an unaccredited burns and plastic surgery registrar at Royal North Shore Hospital in Sydney.


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