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1970 Indian Journal of Ophthalmology Volume 68 Issue 9

Corneal melt in leptospirosis

a b

c d
Figure 1: (a) Corneal edema with descemet folds, 3‑mm hypopyon and subconjunctival
hemorrhage one day after the splash of tissue fluid from the goat.  (b) Hypopyon shows
leptospire with the neutrophils stained using the silver impregnation method. Approximately,
25 leptospires were observed under the microscope with a maximum of eight leptospires
per field (40×). *denotes leptospires and N denotes neutrophil. (c) Corneal melt on the third
day. (d) Corneal perforation with iris prolapse on the fourth day

A 45‑year‑old male patient, a butcher by profession, Correspondence to: Dr. S R Rathinam,

presented to us with complaints of pain and defective vision
in his right eye for one day. The patient gave the history of
a splash of tissue fluid in his right eye while he was cutting
a goat. Upon examination, his corrected vision in the right
eye was 6/36 and the left was 6/6. The right eye showed
stromal edema and descemet fold with 3+  flare cells and
a 3‑mm hypopyon  [Fig.  1a] An anterior chamber tap with
subsequent silver methamine staining was positive for
leptospirosis  [Fig.  1b]. Topical moxifloxacin eye drops and
Tab. Doxycycline 100 mg once a day were started. However,
over the next few days, the cornea melted with an iris prolapse
through the wound [Fig. 1c and d]. Eventually the eye went
into phthisis. Occupational exposures[1] and cell membrane
injuries[2] are known in leptospirosis. However, iatrogenic
moxifloxacin induced corneal melt should also be considered
during differential diagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
Principal, Head of Uveitis Service, Aravind Eye Hospital and
PG Institute of Ophthalmology, Anna Nagar,
Madurai ‑ 625 020, Tamil Nadu, India.
E‑mail: rathinam@aravind.org
References
1. Sturman RM, Laval J, Weil VJ. Leptospiral uveitis. Arch Ophthalmol
1959;61:633‑9.
2. De Brito T, Silva AMGD, Abreu PAE. Pathology and pathogenesis
of human leptospirosis: A commented review. Rev Inst Med Trop
Sao Paulo 2018;60:e23.
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S R Rathinam, Gowri Priya Chidambaranathan
Uveitis Service, Aravind Eye Hospital and
PG Institute of Ophthalmology, Cite this article as: Rathinam SR, Chidambaranathan GP. Corneal melt in
leptospirosis. Indian J Ophthalmol 2020;68:1970.
Madurai, Tamil Nadu, India