Endogenous Panophthalmitis : The Traitor Within !

Aim: To report a rare case of endogenous panophthalmitis in a diabetic with chronic kidney disease undergoing haemodialysis. Methods: A 54 year old male diabetic and hypertensive with chronic kidney disease (CKD) on maintenance haemodialysis through a tunnelled internal jugular vein (IJV) catheter with IJV catheter infection was being treated with parenteral Imipenam. He complained of sudden pain in the left eye with discharge and difficulty in opening the eyelids since 2 days. Examination revealed tense oedematous eyelids, purulent discharge, chemotic congested conjunctiva, hypopyon, proptosis, restriction of ocular movements and progressive diminution of vision. A clinical diagnosis of endogenous panophthalmitis was made and was supported by investigations. Result: With uncontrolled diabetic status, despite intensive systemic antibiotics the condition progressed rapidly. The patient was treated, high local and systemic antibiotics and maintenance haemodialysis. Evisceration was inevitable. Conclusion: Endogenous panophthalmitis is rare. Early intervention is the key to preventing visual loss, but prognosis is poor. Management is challenging in the presence of multiple risk factors.