A Case Report on Fortified Drop Toxicity in Refractory Stromal Abscess

Corneal stromal abscess is an atypical and severe presentation of keratitis. Due to the deep stromal involvement, they pose a major therapeutic challenge. This case report highlights a case of refractory corneal stromal abscess in a 79-year-old diabetic patient with no predisposing risk factors or past history. On clinical examination, corneal haze and midstromal infiltrates with the presence of 1 mm hypopyon in the anterior chamber was observed with a best-corrected visual acuity hand movement. Due to the initial uncertainty with the corneal scraping culture not yielding any growth of microorganisms and Gram, KOH staining showing no evidence of bacterial, fungal or acanthamoeba infection treatment with topical antibiotic fortified drops was initiated every 2 h to ensure effective initial antibiotic coverage which led to corneal epithelial defect measuring 7 mm × 5 mm and no significant improvement in symptoms on follow-up after 1 week. Further course of treatment included intrastromal injection of vancomycin (1 mg/0.1 ml) and amikacin (0.4 mg/0.1 ml) along with topical antibiotics. Upon no significant improvement in the condition, the patient received therapeutic penetrating keratoplasty as part of a comprehensive approach to control the infection and restore corneal integrity. This case highlights the challenge of managing a recalcitrant corneal stromal abscess with epithelial toxicity from prolonged fortified antibiotic drops, requiring targeted intrastromal therapy and corneal healing.