Necrotizing destruction of the ocular adnexa by Pseudomonas aeruginosa.

In a six weeks old boy, a necrotizing Pseudomonas infection had destroyed nearly the whole lid apparatus, the lacrimal structures of the right eye and the medial canthal region, the medial thirds of the eyelids and the lacrimal passages on the left side. The infection was only controlled by intensive antibiotic therapy after more than two weeks. The exposure keratitis of the right eye was followed by corneal perforation, two months after the beginning of the therapy. A keratoplasty was performed, but soon a staphyloma and later, dense scarring developed. After the haematological and immunological situation was under control we could contemplate covering the large defect in the medial canthal area (open right canalis nasolacrimalis) at the age of seven months. The right lower lid has to be reconstructed later. The left eyelid defects have closed by spontaneous granulation. The little boy is no longer receiving antibiotic treatment and is developing very well.