Expert Witness Review of Eye Infections

posted in: Eye Infection

Eye infections can lead to severe loss of vision.  In many cases the infection occurs because of reasons that are beyond the control of medical science.  The following describes a case in which loss of vision from a severe eye infection was linked to allegations of inappropriate diagnosis and improper treatment.  This case is cited as illustrative example as an eye infection that was evaluated by an ocular expert witness.  This case is helpful as an overview; each expert witness analysis of an eye infection must be judged on its own merits and circumstances.

The claimant was 13-year-old female patient who was seen by her optometrist complaining of a “pink eye” following her swimming in motel pool.  Ocular examination showed large chemical burns of the cornea from chlorine exposure.  The claimant reported that she inserted contact lenses quickly after leaving the pool.  Her optometrist reported that the claimant presented with a damp towel that had discharge on it, which she had maintained on her eyes since swimming in the pool several days before.  The optometrist cautioned the mother not to allow us of that towel, since it increased the chance for infection.

The optometrist prescribe Maxitrol eyedrops to help control the chemical burns and prevent infection.  The claimant was seen three days later, after a report of some improvement, she was prescribed Lotemax to clear the cornea.  The rationale for the claimant’s treatment were not documented in the medical record.

After a few days, the patient was seen at another eye clinic for evaluation of cornea irritation.  The patient’s main complaint was of redness in both eyes.  The patient’s mother reported that she had been experiencing redness, burning and throbbing in both of her eyes since swimming in a motel pool, one week prior.  The patient’s mother also stated that her daughter wore daily contact lenses, but that she did not wear them while sleeping or swimming.  The patient reportedly inserted her contact lenses after swimming, and the next day her eyes bcame red and matted.  The patient experienmce matt8ing and redness thereafter.  The patuient’s review of symtoms was otherwise negative.  She also had a negative past medical history.

Following exam on this visit by an ophthalmologist, the patient was diagnosed with bilateral severe corneal ulcers with hypopyon and possible endophthalmitis, and possible perforation of the left eye.  The patient was referred for specialized treatment to another facility.  Meanwhile, the antibiotics were discontinued , as was the Lotemax that was previously prescribed by her optometrist.

The patient was transferred tp a specialty facility for evaluation and treatment.  The patient reported that she developed blurriness and redness in the left eye, which progressed to the right eye following swimming in a motel pool.  Examination showed a thick, green discharge from both eyes, with loss of vision, two days after the onset of her symptoms.  The patent also reported pain when opening and closing of her eyes, but minimal pain when her eyes were closed.  She denied headache, fever, nausea, vomiting, or dizziness.  There was no prior surgical history.  All other family members, including her parents and one younger brother, were healthy.

Evaluation by an ophthalmologist at the specialty clinic indicated that the patient was still wearing contact lenses, apparently even after she had begun having problems with her eyes subsequent to swimming with her lenses.  The patient reported that her vision had been blurry since the onset of problems, and that she could see only light in both eyes.  Ocular examination was notable for thick, green discharge from both eyes, and severe corneal infiltrates in both eyes.  No pain was elicited with shining a light into her eyes.  Extraocular movements were intact with minimal pain.

The diagnosis was bilateral corneal ulcers.  Bacterial cultures were taken of both eyes and sent for analysis.  The patient was started on Vancomycin and Ceftazidine drops to both eyes.  The patient was also started on Ampilicillin.

The patient’s symptoms improved and although she still felt pain a few days later, it was getting better.  The treatment plan included continued use of antibiotic drops, and placement of patch and shield on her eyes when eyedrops were not being used.

Examination a few days later showed severe thinning of the cornea in the left eye.  The iris was pushed against the cornea, and the patient did not have vision in each eye.  The culture results showed pseudomonas eye infection.  Pseudomonas is a particularly virulent type of bacteria.

Early the following month the patient underwent a penetrating keratoplasty (corneal transplant) of the left eye due to corneal ulcer with perforation.  The patient tolerated the procedure well, after which her eye was patched and fortified antibiotic drops started.  The patient was subsequently ably to distinguish the color blue in the scribes worn by the hospital staff.The corneal ulcer in her right eye was still noted to have central corneal thinning and an epithelial defect.

Six months later, the patient underwent additional surgery wit a corneal transplant in the other eye.  She continued to treat for this condition and her vision has improved but only to a limited extent.

Plaintiff’s Position
The plaintiff claims that the patient originally presented with pseudomonas, which was not properly diagnosed by the optometrist.  The plaintiff’s also claims that the optometrist failed to treat the patient properly and should have prescribed different eyedrops and made a quicker referral to an ophthalmologist.

Defendant’s Position
The optometrist claims that he originally diagnosed chemical burns of the eye, which was likely caused by swimming, with contacts, in an overly chlorinated pool, or the immediate insertion of contact lenses thereafter.  The optometrist is also of the opinion that because the patient continued to use a warm and moist towel compression over here eye, in order to alleviate the pain, this led to contracting of the pseudomonas infection.

Expert Analysis
An ocular expert was consulted to evaluate the standard of care for each patient visit to the optometrist.  The analysis revolved around the issues of what steps he should have taken, if he breached the standard of care, and what the prognosis is for the patient.  The ocular analysis also included a cost estimate for any future treatment.

An expert witness review may be helpful when analyzing diagnosis and treatment in patients with eye infections.  Multiple factors  need to be taken into account to determine if the standard of care has been met.

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