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13 INNOSC Theranostics and Pharmacological Sciences, 2022, Vol. 5, No. 2 Yanik et al.
factor through the contaminated pool. The fact that
the pathogen is susceptible to so many antibiotics
also supports our opinion that it is environmentally
acquired.
The intact cornea is normally resistant to invasion
by P. aeruginosa [10]. Probably, nasolacrimal duct
obstruction facilitated corneal trauma. Furthermore,
the patient had a story of using corticosteroid
drops. All of these reasons caused the patient to
be susceptible to polymicrobial keratitis. As in
the case of Hue et al., if the pathogen invaded the
anterior chamber, systemic anti-biotherapy was
needed [11]. However, local treatment was enough
Figure 4. Corneal appearance after treatment. because there was no sign of invasion in our case.

were used in the evaluation of antimicrobial resistance 4. Conclusion
patterns.
As for the treatment regime, moxifloxacin eye P. aeruginosa keratitis is a disease that should be
drops and ganciclovir gel were prescribed. The treated seriously, as it causes visual impairment
corneal haze disappeared on the tenth and final day if diagnosis is delayed. P. aeruginosa keratitis
of the treatment (Figure 4). should be considered in the differential diagnosis,
Congenital nasolacrimal duct obstruction may particularly for infants, when there are risk
have been a predisposing factor for the patient. factors such as poor hygiene, contact lens usage,
Early probing was suggested to the patient. treatment-resistance keratitis, visual disturbances,
and nasolacrimal duct obstruction identified in the
3. Discussion differential diagnosis.

In the presented case, the isolated microorganism Acknowledgments
is associated with pathogenic keratitis, which plays
a crucial role in keratitis. Environmental factors None.
such as poor hygiene and trauma are important risk
factors for keratitis. In the literature, keratitis cases Funding
caused by P. aeruginosa are usually associated with No funding was received for this study.
contact lens usage. This pathogen is rarely reported
in infants without hospitalization history. As Conflict of interest
infants can not describe their complaints, diagnosis
in infants can be delayed. Antibiotic resistance is a The authors declare that they have no competing
significant factor contributing to treatment delays. interests.
If treatment is delayed, this pathogen can invade
the cornea, anterior chamber, and aqueous humor. Author contributions
Congenital nasolacrimal duct obstruction Conceptualization: Keramettin Yanik
is one of the risk factors for infants [8]. Data Formal analysis: Hatice Buse Uras, Celal Yeter
published by Li et al. shows that human tear Investigation: Keramettin Yanık
fluid can protect against P. aeruginosa, the major Supervision: Celal Yeter
opportunistic pathogen, independently of its Writing – original draft: Hatice Buse Uras
bacteriostatic activity [9]. In our case, the patient Writing – review & editing: Hatice Buse Uras
had nasolacrimal duct obstruction. Furthermore, Ethics approval and consent to participate
the patient had a story of swimming in a pool at a
farm. We considered that the pathogen infected the Informed consent was obtained from the study
patient with a nasolacrimal duct obstruction risk subject’s guardians for participating in the study.

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