Bilateral Fungal Keratitis In A Patient With Floppy Eyelid Syndrome And Atopic Keratoconjunctivitis

To present a rare case of bilateral fungal keratitis in a patient suffering from floppy eyelid syndrome and atopic keratoconjunctivitis.

2nd Department of Ophthalmology

Aristotle University of Thessaloniki

Papageorgiou General Hospital

Thessaloniki, Greece

A 44-year-old male presented to our emergency department complaining about blurry vision, ocular redness, and mucopurulent discharge starting a week ago. He reported applying tacrolimus 0.03% to both eyes twice a day as a treatment for atopic keratoconjunctivitis and topical steroids occasionally. Upon examination, he had excessive central corneal ulcers bilaterally, with marked conjunctival injection and hypopyon, while his visual acuity was finger counting and hand motion perception in his right and left eye respectively. Corneal scapes were obtained from both eyes and the culture came positive for Candida albicans. Steroids and tacrolimus were stopped and the patient was set on fortified antibiotics and topical voriconazole. Besides a later co-infection with Staph aureus in the left eye, the patient had a favorable course with healing of the corneal ulcers and inflammation remission. Floppy eyelids were managed surgically to avoid further complications.

The administration of topical steroids and tacrolimus in atopic keratoconjunctivitis, although beneficial, should be performed with caution, especially in patients with a high risk for corneal epithelial defects as in eyes with lid abnormalities. This protocol highlights the need for strict protocols and regular follow-ups in such patients to avoid vision-threatening complications.