without staining or infiltrate.
Funduscopic exam was unchanged from prior examinations,
demonstrating extensive macular pigment atrophy
bilaterally without hemorrhage. Given the sterile appearance,
she was started on Tobradex (tobramycin/dexamethasone)
ophthalmic ointment four times daily. She
was evaluated by the retina service 6 days after initial presentation
with an unchanged funduscopic exam without
evidence of ocular ischemia and a stable corneal exam.
Upon follow-up 2 weeks after initial presentation, her
visual acuity in her left eye was 4/200e at distance and 20/
800 at near, there was 2+ conjunctival injection, there
were dilated iris vessels, and her left cornea had a central
1.5-mm area of 90 % thinning with epithelial defect but
still no infiltrate. Tobradex was stopped, she was started
on doxycycline 100 mg twice daily and Vigamox four times daily, and corneal cultures were obtained. Clinical
labs were negative, including c-ANCA, p-ANCA, ANA,
myeloperoxidase antibody, PR-3 antibody, syphilis IgG,
and rheumatoid factor level of 10 units. Cultures from her
left cornea grew methicillin-resistant Staphylococcus aureus
(MRSA) within 48 h. Vancomycin 25 mg/cc drops was
added every 2 h, and oral doxycycline and Vigamox were
continued. She was seen regularly for follow-up with eventual
healing of her epithelial defect over the following
month. Two months after initial presentation, she developed
an acute conjunctivitis in her left eye.