Lo and behold! An inverted hypopyon in the cornea! – Intrastromal sequestered corneal infection

Abstract

To report two unique cases of intrastromal liquified corneal abscess following penetrating trauma to the cornea. We report two cases of a 12-year-old and an 11-year-old child who developed liquified purulent intrastromal fluid collections corneal abscess following penetrating trauma to the cornea. We present the investigative workup and the subsequent management with a review of the literature and describe a new “inverted hypopyon in the corneal stroma” sign to characterize the diagnosis. No similar cases have been reported so far. A provisional diagnosis of intrastromal corneal abscess was made in both cases, and surgical intervention was undertaken. Patient 1 was planned for abscess drainage, and Patient 2 was planned for penetrating keratoplasty along with abscess drainage. The drained pus was sent for bacterial and fungal culture and antimicrobial sensitivity. Both patients were treated with topical moxifloxacin 0.5% for 4 weeks and regained good vision with no recurrence of infection in the postoperative period. We conclude that intrastromal corneal abscesses are usually common following penetrating trauma but mostly involve all the layers of the cornea, often leading to corneal perforation. Such cases are mostly fungal in nature. However, our patients presented with a well-defined intrastromal bacterial abscess with liquified pus creating an “inverted hypoyon in the corneal stroma” sign and were effectively managed surgically. Such cases and the clinical sign have not been reported before.