Sequential Inflammatory and Pupillary-Block Ocular Hypertension in Streptococcus suis Endogenous Endophthalmitis: An Observational Analytic Case Study
DOI:
https://doi.org/10.37275/bsm.v10i10.1669Keywords:
Endogenous endophthalmitis, Glaucoma, angle-closure, Intraocular pressure, Streptococcus suis, ZoonosesAbstract
Background: Streptococcus suis, a zoonosis acquired from pigs and raw pork, is a rare cause of endogenous endophthalmitis, and no quantitative account of the pressure complications of such an eye has been published.
Objective: To characterize, in a single culture-proven case of Streptococcus suis endogenous endophthalmitis, the two mechanisms and the course of the raised intraocular pressure, and to derive the clinical implications for management.
Methods: a structured analysis of one culture-proven case managed at a tertiary hospital in Bali, Indonesia, over 48 days. Acuity was converted to logMAR on four published scales, all 19 pressure readings were analysed with a repeatability model, and corticosteroid causation was scored with the Naranjo instrument.
Results: a 46-year-old man who had eaten raw pork a week earlier presented with meningitis, reduced hearing and a left eye with light perception, hypopyon and vitritis. Cerebrospinal fluid and vitreous both grew S. suis. Pressure rose in two distinct episodes: an inflammatory one peaking at 29.0 mmHg on day 7, and a pupillary block from posterior synechiae with iris bombé peaking at 30.0 mmHg on day 16, which fell 11.0 mmHg after iridotomy with simultaneous reintroduction of timolol. Corticosteroid causation scored 3, a value largely fixed by the temporal sequence alone. Acuity improved by 0.70 logMAR overall, but the division of that gain across the vitrectomy reversed with the conversion scale: 0.40 before and 0.30 after by clinical convention against 0.10 and 0.60 with measured hand-movement values. The eye remained blind.
Conclusion: raised pressure in such eyes is not one entity, the pupil must be examined before pressure-lowering therapy is escalated, and a logMAR change at this level of vision is uninterpretable unless its scale is stated.
Authors
- Dewa Ayu Ina Dianata1
- I Gusti Ayu Made Juliari2*
- I Gusti Ayu Ratna Suryaningrum2
- Ni Made Ari Suryathi2
- Anak Agung Ayu Suryapraba Indradewi3
- 1Ophthalmology Study Program, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
- 2Department of Ophthalmology, Faculty of Medicine, Universitas Udayana/Ngoerah Hospital, Denpasar, Indonesia
- 3Department of Neurology, Faculty of Medicine, Universitas Udayana/Ngoerah Hospital, Denpasar, Indonesia
Corresponding author I Gusti Ayu Made Juliari — arie_mata@yahoo.com
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Copyright (c) 2026 Dewa Ayu Ina Dianata, I Gusti Ayu Made Juliari, I Gusti Ayu Ratna Suryaningrum, Ni Made Ari Suryathi, Anak Agung Ayu Suryapraba Indradewi
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