Subconjunctival injections and povidone-iodine washings for the treatment of giant fornix syndrome

Cornea. 2011 Apr;30(4):479-80. doi: 10.1097/ICO.0b013e3181eeb703.

Abstract

Purpose: Giant fornix syndrome is a chronic copiously purulent conjunctivitis seen in elderly patients with dehiscence of the levator palpebrae superioris aponeurosis. We report a case of giant fornix syndrome secondary to methicillin-resistant Staphylococcus aureus conjunctivitis that was recalcitrant to standard treatment modalities, and we describe 2 novel interventions for this condition, which succeeded in eradicating the infection.

Methods: Case report.

Results: After failing an aggressive treatment course of topical antibiotics and corticosteroids and after demonstrating an inability to tolerate oral antibiotics, the patient was treated with supratarsal subconjunctival injections of vancomycin and triamcinolone, followed by repeated sweepings of the conjunctival fornices with 10% povidone-iodine on a cotton swab. The patient's symptoms improved dramatically after the antibiotic and corticosteroid injections and ultimately resolved completely after multiple povidone-iodine sweepings.

Conclusions: In patients with giant fornix syndrome who are recalcitrant to or intolerant of aggressive topical and systemic therapy, supratarsal subconjunctival injections of antibiotics and corticosteroids and sweeping of the conjunctival fornices with povidone-iodine are 2 local treatments which may be useful in eradicating the infection.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Anti-Infective Agents, Local / therapeutic use*
  • Chronic Disease
  • Conjunctiva
  • Conjunctivitis / drug therapy*
  • Conjunctivitis / microbiology
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / drug therapy*
  • Eye Infections, Bacterial / microbiology
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Injections
  • Methicillin-Resistant Staphylococcus aureus / drug effects*
  • Povidone-Iodine / therapeutic use*
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / microbiology
  • Syndrome
  • Therapeutic Irrigation
  • Triamcinolone Acetonide / therapeutic use
  • Vancomycin / therapeutic use

Substances

  • Anti-Infective Agents, Local
  • Glucocorticoids
  • Vancomycin
  • Povidone-Iodine
  • Triamcinolone Acetonide