Chronic Keratoconjunctivitis Sicca Due To Genital Infection By Acinetobacter Baumannii.

Keratoconjunctivitis sicca is a bilateral chronic drying of the conjunctiva and cornea due to a qualitative or quantitative alteration of the tear film. Symptoms are dominated by pruritus, burning, irritation and photophobia.

The frequent negativity of corneo-conjunctival samples encourages us to actively seek an extraocular infectious focus.

The ophthalmologist, faced with keratitis sicca, must consider genital infection as a possible cause.

Our study concerns the case of a 39-year-old patient followed in the internal medicine and rheumatology department for a chronic dry syndrome, who consults for tearing with redness, ocular pruritus, a decrease in visual acuity, associated with foreign body sensation, treated repeatedly through symptomatic treatment without resolution.

The interrogation found gynecological warning signs in the patient who reported repeated episodes of vaginal pruritus.

The ophthalmological examination finds:

A best corrected visual acuity of 20/20 for both eyes.

Conjunctival irritation with diffuse superficial punctate keratitis more marked lower and a break up time test of 3 seconds in both eyes.

A vaginal swab was taken that showed the presence of acineto bacter Baumannii.

The patient is put under lubricant agents without preservatives and topical healing agents with vitamin A coupled with an etiological treatment based on ciprofloxacin at the rate of 500 mg in 2 doses per day for a period of 14 days.

At the end of the treatment, a cervico-vaginal control sample was taken that came back negative. Clinically, there is an improvement of the ocular signs of and the quality of the tear film.

Damage to the ocular surface is frequent and can sometimes compromise the functional prognosis. The frequent negativity of corneo-conjunctival samples prompts us to actively search for an extraocular infectious focus.

The isolation of a germ in the urogenital tract or in another focus and the beneficial effect of the appropriate therapy after unsuccessful routine treatment suggest more than a probability that this infection is directly or indirectly responsible for these damages of the ocular surface.

The physiopathological mechanism linking these chronic ocular allergic and inflammatory manifestations to these extra-ocular infections is complex and still unclear.

Genital infections can be directly or indirectly responsible for chronic damage to the ocular surface. The treatment of these manifestations involves the eradication of the responsible germ

The resolution of ocular signs after administration of appropriate treatment shows the involvement of the extraocular infectious focus in the genesis of chronic inflammation of the ocular surface.