Fulminant pseudomonal keratitis and scleritis in human immunodeficiency virus-infected patients
M. Nanda, S. C. Pflugfelder and S. Holland
Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33101.
Patients with human immunodeficiency virus infection are predisposed to
fungal, parasitic, and viral infections. Bacterial infection can also be
seen, although ocular bacterial infections have not been reported in
patients with acquired immunodeficiency syndrome until recently. We present
two cases of Pseudomonas corneoscleritis and one case of Pseudomonas
keratitis in patients with human immunodeficiency virus infection that
failed to respond to antibiotic treatment. Predisposing factors included
extended-wear soft contact lens use in one patient and exposure secondary
to Bell's palsy in another patient. All three patients had neutropenia that
may have contributed to their poor response to treatment. Enucleation was
required to treat two patients with overwhelming infection. Enucleation has
been rarely required for treatment of corneoscleritis in immunocompetent
patients treated at our institution. Pseudomonas keratitis in human
immunodeficiency virus-infected patients represents a serious ocular
infection requiring early diagnosis and aggressive treatment.
