Management Approach in Patient with Type 2 Diabetes Mellitus with Bacterial Corneal Ulcer Associated with Diabetic Keratopathy : A Case Report

Abstract

Introduction: Diabetes with long standing hyperglycemia commonly causing peripheral neuropathy including corneal nerves. It may lead to delayed diagnosis or underdiagnosed because of asymptomatic due to decreased corneal sensation. Objective: To report a case of secondary bacterial infection of corneal ulcer due to diabetic keratopathy. Case Presentation: A female 63 years old came to ER with a major complaint of pain in her right eye since 2 weeks prior admission. The patient has medical history of long standing diabetes mellitus. She worked as a farmer on rice paddy field. Physical examination in the ER found in the right eye region, positive light perception visual examination, conjunctival hyperemia, subconjunctival abscess, corneal ulcer, hypopyon were found in the anterior chamber of the eye, positive fluorescence test with iris, pupil and lens which is difficult to evaluate. Laboratory result showed mild anemia (10,6), random blood glucose 188 mg/dL, Diabetes Neuropathy Symptom score 2. Discussion: Therapy glycemic control switch from oral to insulin basal bolus subcutan, diet 1800 kkcal per day, gabapentin, antibiotic subconjunctival injection and eye drops, planned for elective cryo-surgery. Patient showed clinical improvement with decreased signs of infection and ocular pain, glucose undercontrolled with insulin. Conclusion: Diabetes mellitus with long standing hyperglycemia should be screened for symptoms of neuropathy. Early diagnosis and treatment could help prevent progressive complications.