A First Reported Case Of Peripheral Ulcerative Keratitis Superinfected With Actinomyces Oris

To describe the management of a case of Peripheral Ulcerative Keratitis (PUK) super-infected with Actinomyces Oris. To the best of our knowledge this is the first described case of PUK super-infected with this organism. 

Ophthalmology Department, University College Hospital Galway, Ireland

An 80 year old lady with a history of Rheumatoid Arthritis presented with an acutely painful and red right eye. Visual acuity was reduced at 6/18. On examination she had a 1.5 by 3mm area of corneal thininng in the juxta-limbal cornea inferiorly. There was associated epithelial defect and stromal infiltrate. 

A gentle scrape of the infiltrate was performed in the casualty and she was admitted to the hospital for treatment. She was treated initially with intensive topical Vancomycin and Ceftazidime, regular lubricants, oral Vitamin C and Doxycycline. She was also commenced on systemic oral steroid.

The corneal scrape grew Actinomyces Oris. She improved with treatment and the Vancomycin/Ceftazidime was gradually tapered and switched to topical Moxifloxacin. Topical steroid was introduced once re-epithelialisation was complete. Visual acuity at 8 weeks was excellent (6/6) but unusually a small 0.8mm infiltrate persisted.  

PUK risks super-infection with micro-organisms as the epithelial barrier is lost. This is the first case we know of that reports super-infection with Actinomyces Oris. This organism is normally a commensal of the oropharynx. In our case the lady responded very well to conventional treatment and had an excellent visual outcome. Super-infected PUK presents a therapeutic challenge as there needs to be a balance struck between treating both the infective and inflammatory components.