Adjunctive Subconjunctival Dexamethasone In Severe Traumatic Corneal Ulcer Complicated By Endophthalmitis: A Case Report

To report outcomes of adjunctive subconjunctival dexamethasone administered under intensive topical, intravitreal, and systemic antimicrobial therapy in severe traumatic corneal ulcers complicated by endophthalmitis, a condition in which steroid use is traditionally considered contraindicated.

Tertiary referral ophthalmology center providing emergency ocular trauma care.

Two patients with delayed presentation after ocular trauma were admitted with large central purulent corneal ulcer, corneal edema, hypopyon, secondary ocular hypertension, and clinical endophthalmitis. Visual acuity at presentation was light perception with inaccurate projection of light in both cases. Posterior segment visualization was not possible due to corneal opacity. B-scan ultrasonography revealed dense vitreous opacities with an attached retina, and computed tomography showed no intraocular foreign body.

During the first intravitreal procedure, microbiological samples obtained from the corneal ulcer and anterior chamber revealed gram-positive bacteria in both patients.

Treatment included daily subconjunctival injections of dexamethasone (0.3 ml) combined with gentamicin (0.3 ml), atropine (0.1 ml), phenylephrine (0.1 ml), and lidocaine (0.2 ml). Intravitreal antibiotics (vancomycin and ceftazidime) were administered three times at 48-hour intervals, along with systemic intravenous moxifloxacin (400 mg/250 mL). Intensive topical antibacterial therapy, cycloplegics, and intraocular pressure–lowering agents were used.

In both cases, progressive epithelialization and complete healing of the corneal ulcers were achieved without perforation. Hypopyon and intraocular inflammation resolved, intraocular pressure normalized, and endophthalmitis was successfully controlled. Globe integrity was preserved, while final visual acuity remained light perception.

Although corticosteroids are generally contraindicated in active corneal ulcers, these cases demonstrate that, under microbiological confirmation and intensive topical, intravitreal, and systemic antimicrobial coverage, adjunctive subconjunctival dexamethasone may aid inflammation control, corneal healing, and globe preservation in selected severe traumatic infections. Careful patient selection and close monitoring are essential.