Purchase this article with an account.
L. J. Wong, C. C. Patel, E. Hink, V. Durairaj, S. C. Oliver; Fusobacterium nucleatum Endophthalmitis Following Dental Procedures. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3532.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To analyze the etiology of Fusobacterium nucleatum endophthalmitis following injection of anesthesia for a dental procedure.
We retrospectively study a 49-year-old, healthy female who experienced severe left ocular pain immediately after anesthetic injection for a left-sided tooth extraction.
The patient presented with best-corrected visual acuity of 20/20, conjunctival injection, chemosis, intra- and sub-retinal granuloma, and pan-uveitis. Extensive laboratory testing did not reveal an etiology. She was treated for toxoplasmosis, and then tuberculosis, but she continued to worsen. The eye progressed to total exudative retinal detachment and no light perception. Intravitreal samples showed culture-negative inflammation. Intravitreal injection of vancomycin, ceftazidime, and voriconazole temporarily stabilized her eye. She then developed extremely painful neovascular glaucoma refractive to cyclophotocoagulation, and the eye was enucleated, showing heavy Fusobacterium nucleatum on culture. Histopathology showed fulminant inflammation throughout the eye, with gram-negative filamentous rods suggestive of Fusobacterium nucleatum. Pain resolved after enucleation and oral penicillin. The timing of eye pain and symptoms immediately after the dental anesthetic raises the suspicion of inoculation with oral flora at the time of the dental procedure. The pathway could be from simple diffusion or hematologic, but the immediate pain correlates with direct inoculation, likely through the maxillary sinus or inferior orbital fissure. There have been cases of dental needles entering the orbit during dental anesthetic, but never causing endophthalmitis before.
Endophthalmitis is a rare complication following dental procedures for which a high index of suspicion is necessary for prompt diagnosis and treatment.This appears to be the first occurrence of Fusobacterium nucleatum endophthalmitis following a dental procedure, and with a previously undescribed etiology - likely direct inoculation.
This PDF is available to Subscribers Only