Two cases of fulminant Bacillus cereus endophthalmitis with distinct anatomical prognoses following farm-related open globe trauma: a two-case comparative report

Farm-related open globe wounds contaminated with soil carry a high risk of rapidly progressive Bacillus cereus endophthalmitis, which may lead to extensive retinal liquefactive necrosis within 24–48 h. Most existing literature consists of single-case reports; comparative cases with distinct anatomical prognoses are scarce. This report describes two patients with farm-related soil-contaminated open globe trauma but divergent disease courses to illustrate the clinical spectrum and highlight the need for urgent intraocular antimicrobial treatment and vitreoretinal assessment. Case 1 was a 64-year-old female farmer with a soil-contaminated metallic intraocular foreign body. She presented 4 h after injury with visual acuity (VA) of 0.4 but deteriorated rapidly to no light perception (NLP) within 24 h of admission (approximately 28 h after injury). Emergency pars plana vitrectomy (PPV) with foreign-body removal and silicone oil tamponade was performed; intraoperatively, diffuse circumferential retinal liquefaction was observed. She had a final VA of NLP with a stable globe at three-month follow-up. Case 2 was a 66-year-old male farmer with farm-related penetrating trauma and repeated eye rubbing. He presented 48 h after injury with NLP, orbital cellulitis, and globe rupture. Evisceration with orbital drainage was performed to prevent intracranial spread. Both isolates demonstrated intrinsic resistance to penicillins but were susceptible to vancomycin and levofloxacin. Farm soil-contaminated penetrating trauma is a high-risk factor for fulminant Bacillus cereus endophthalmitis. Rapid retinal necrosis within 24–48 h of injury represents a clinically fulminant phenotype that should prompt urgent intraocular antimicrobial treatment and vitreoretinal assessment. These two cases illustrate a broad spectrum from globe salvage with permanent vision loss to evisceration, and underscore the importance of avoiding eye rubbing and seeking immediate ophthalmic care after farm ocular trauma. Larger studies are needed to validate prognostic factors and optimal surgical timing.