Infection of the cornea with B. pyocyaneus. Clinical study and summary of ten cases personally observed.

CORNEAL ulcers of a very severe nature and recognizable clinical appearance are caused by infection with Bacillus pyocyaneus. Practically the only severe corneal ulcers (i.e., those involving loss of the eye, or states approaching this, within a day or so of admission) seen at the Moorfields Branch in the course of a year were due to this organism. The typical history is as follows: The patient has a minor injury or abrasion with or without removal of a foreign body from the cornea. Approximately 3 days later a severe, painful corneal ulceration arises with opaque dead-white centre and perhaps an hypopyon. This extends rapidly, at first without breaking the surface epithelium and then with central superficial necrosis, and leads to a later stage with a dead-white ring of infiltration and semitransparent central area. The opportunity of observing, in epidemological form, several cases of corneal infection with B. pyocyaneus is rare. The severity of these infections has been emphasized by Joy (1942) who reviewed 64 cases found in the literature; loss of the eye or loss of useful vision occurred in nineteen of the 23 reported since 1922. His experimentally produced B. pyocyaneus ulcers in rabbits were healed in 57 per cent. by oral administration of sulphonamides, no human case being treated. Brown (1943) added three more cases; the affected eye in two was enucleated and in the other the eye, although saved, had greatly reduced vision after sulphonamide therapy. Juler and Young (1945) treated a case with penicillin without effect. Maschler (1948) reported a case treated heroically with penicillin, streptomycin, and Saemisch section, the eye being retained in the orbit. Pendexter (1948) reported a case of corneal ulceration