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JAMA Ophthalmology Clinical Challenge
March 1, 2018

Conjunctival Hyperemia or Vasodilation and Central Corneal Ulcer in a Neonate

Author Affiliations
  • 1University of Miami Miller School of Medicine, Miami, Florida
  • 2Bascom Palmer Eye Institute, Miami, Florida
JAMA Ophthalmol. Published online March 1, 2018. doi:10.1001/jamaophthalmol.2017.5159

An 11-day-old girl presented with a worsening corneal opacity of the right eye. The patient had received a diagnosis of conjunctivitis at 6 days of life but failed to respond to treatment with topical erythromycin ophthalmic ointment, 0.5%. The baby was an otherwise healthy girl born at full term. Her perinatal history was significant only for a positive maternal test for group B Streptococcus agalactiae, which was treated prior to delivery.

Results of the initial examination were significant for conjunctival hyperemia or vasodilation of the right eye, with a 3 × 4-mm central corneal ulcer. Results of B-scan ultrasonography showed no posterior chamber involvement. Corneal cultures for bacteria, fungi, and herpes simplex virus were obtained. Owing to concern for systemic involvement of group B S agalactiae, herpes simplex virus, and other infectious causes, the patient was admitted to the children’s hospital for a full sepsis workup. Treatment with topical polymyxin B sulfate-trimethoprim and intravenous ampicillin, cefepime hydrochloride, and acyclovir sodium was initiated. Results of spinal ultrasonography demonstrated spinal cord tethering at L4, preventing lumbar puncture and collection of cerebrospinal fluid for culture.

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