Ophthalmology · Cornea (Infectious and Non-Infectious Keratitis, Ulcers)

A 62-year-old farmer presents with a 4-day history of a painful red eye. Slit-lamp examination shows a dense central corneal ulcer with sharply defined margins and a 2 mm sterile-looking hypopyon. Which organism is classically associated with this presentation?

  • A Pseudomonas aeruginosa
  • B Aspergillus fumigatus
  • C Streptococcus pneumoniae
  • D Staphylococcus epidermidis
Correct answer: C. Streptococcus pneumoniae

Explanation

The pneumococcus is the classical cause of hypopyon corneal ulcer: a central ulcer with defined edges and a sterile hypopyon, typically in an elderly or debilitated patient after minor trauma. Pseudomonas produces a rapidly suppurating, spreading ulcer with mucopurulent discharge rather than a discrete ulcer with sharp borders.

Reference: Parsons' Diseases of the Eye, 23rd ed.

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