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JAMA Ophthalmology Clinical Challenge
June 3, 2021

Purulent Conjunctivitis and Progressive Corneal Stromal Necrosis

Author Affiliations
  • 1School of Medicine, University of California San Francisco, San Francisco,
  • 2Department of Ophthalmology, University of California San Francisco, San Francisco
  • 3Francis I. Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco
JAMA Ophthalmol. Published online June 3, 2021. doi:10.1001/jamaophthalmol.2020.5442

A 65-year-old man presented with worsening right eye pain and purulent discharge. He reported being hit in the face by a tree branch several days prior. His medical history was notable for HIV, with a last known CD4 lymphocyte count of 112 cells/mm3 and variable adherence to antiretroviral therapy. At an outside hospital, cultures were obtained, and treatment was initiated with ofloxacin eye drops, 0.3%, ciprofloxacin hydrochloride ointment, 0.3%, and oral moxifloxacin hydrochloride, 400 mg daily. His symptoms worsened, and he was referred 3 days later for further evaluation.

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    1 Comment for this article
    Excellent discussion
    Joseph DeRose, OD, MS | Private practice
    Thank you for this review. A valuable lesson can be learned relative to the red herring tree branch injury. Although Ocham's Razer can often be applied to a relatively clear cut initial presentation, I am reminded to always expand the possibilities when inconsistencies are confronted. Great article.