Presence Of Intracorneal Air Bubbles During The Resolution Of A Severe Corneal Abscess Due To Pseudomonas Aeruginosa.

To expose, through clinical photography and anterior segment OCT image, a case of infectious keratitis. It was complicated by deep stromal abscess that developed  intralesional air bubbles during its resolution. To propose the possible pathophysiological mechanisms involved in the development of intralesional air bubbles in corneal abscess.

Clinical case with follow-up and management from December 2023 to february 2024 in the Ophthalmology Department  in an University third level hospital in Granada, Spain

We present a case of a 41-year-old male, contact lens user, who presented to  our Service complaining of redness, pain and discharge on his left eye. In slit lamp a epithelial defect of 7x9 mm plus central deep stromal abscess and 2 mm hypopyon were observed. Corneal samples were collected and sent to the Microbiology department and  topical antibiotics (vancomycin and ceftazidime) were started. On the third day of treatment a partial response was seen on the slit lamp; the epithelial defect and stromal abscess were reduced.  The presence of intracorneal air bubbles appeared after a week of antibiotic therapy and resolved spontaneously.

The corneal culture was positive for Pseudomonas Aeruginosa sensitive to amikacin and tobramycin. After treatment with targeted topical antibiotic therapy, the patient showed improvement in the infection. The presence of a persistent epithelial defect and the development of corneal neovessels determined treatment with amniotic membrane graft. The final best corrected visual acuity stabilized at 20/30.

Pseudomonas keratitis is common among contact lens users, however, the presence of air bubbles is not a common sign. We have investigated the literature looking for clinical cases or corneal images with similar lesions to guide us in the pathophysiology and origin of intralesional air bubbles, without finding related bibliography. We raise the possibility that an aggressive and rapid course of the lesion could have caused a cavitated abscess that releases air from its interior during its resolution. More studies and experience with this injury are required to obtain determinant conclusions.