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Bilateral blindness due to endophthalmitis and corneal ulcer caused by E. faecalis as a result of chronic intentional self-injury

INTRODUCTION/OBJECTIVES: Endophthalmitis and corneal ulcer are complications of a long-term neglected keratitis and other eye infections. In serious cases they can lead to rapid deterioration in vision acuity and even complete blindness. CASE PRESENTATION: We present a case of 56-year- old obese woman coming to our department complaining about blurry vision in her left eye for the last six months with unspecific skin lesions on her face, lips, eyelids and abdomen. Complete serological and immunological diagnostic panels were performed to exclude systemic autoimmune diseases such as SJS and SLE which were our primary concern. Corneal scraping was positive on E. faecalis which caused the corneal ulcer. She was treated with corticosteroid injections and antibiotics according to antibiogram. After discharge, a few months later, she was readmitted with the same diagnosis, now on her right eye, followed by a severe case of endophthalmitis. At this point, the patient only saw hand movements and had modest light perception. Suspicion to self-injury in a form of constant scratching and crust tearing was raised. The patient continuously denied self-harming, did not follow up on given therapy and psychiatric evaluation which eventually led to complete blindness and permanent immobility due to morbid obesity. With little family support, obvious self- neglect, and GP's inability to motivate her, the patient passed away from respiratory failure. CONCLUSION: Although a rarity, intentional mechanical eye trauma should be considered in progressive and etiologically unclear eye pathology. By setting proper diagnosis earlier and with psychiatric treatment, this case could have had a different outcome.

corneal ulcer, E. faecalis, endophthalmitis, psychiatric disorder, self-harm

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