Exogenous Helminthosporium endophthalmitis.

Case report A 60-year-old non-insulin dependent diabetic man gave a history of uneventful left eye extracapsular cataract extraction and intraocular lens (IOL) implantation in the middle of December 1992. Four months earlier, he had undergone IOL surgery in the right eye. He had recovered well, when he accidentally injured his left eye with a branch of a tree 6 weeks after surgery. He reported to his ophthalmologist with pain, redness, and reduction in vision. Examination revealed prolapse of the iris at 11 o'clock limbus with 1 mm hyphaema. The prolapsed iris was repositioned and the corneoscleral wound was sutured. He was put on topical ciprofloxacin, betamethasone, and cyclopentolate. He was apparently comfortable for 3 weeks when he complained of renewed pain with gross reduction in vision and was referred to us for further management. On examination, the left eye visual acuity was perception of light with accurate projection. The applanation pressure was 7 mm Hg. Slit-lamp examination showed lid oedema, congested conjunctiva, 3 x 2 mm posterior corneal abscess corresponding to previous area of corneoscleral dehiscence, and exudates over the pupillary area occluding the view of the IOL, vitreous, and the retina (Fig 1). Contact ultrasonography showed medium amplitude mid and posterior vitreous opacities. A clinical diagnosis of exogenous endophthalmitis was made. After baseline renal function tests he was put on intensive systemic and topical medications (intravenous gentamicin 80 mg every 8 hours; intravenous cefazoline 1 g every Figure 2 Lactophenol cotton blue mount ofthe culture showing long straight conidiophores swollen at the point; of conidia production. The septae are transverse and dematiaceous conidia are oblong, characteristic of Helminthosporium.