Giant fornix syndrome is a chronic copiously purulent conjunctivitis seen in elderly patients with dehiscence of the levator palpebrae superioris aponeurosis. We report a case of giant fornix syndrome secondary to methicillin-resistant Staphylococcus aureus conjunctivitis that was recalcitrant to standard treatment modalities, and we describe 2 novel interventions for this condition, which succeeded in eradicating the infection.
After failing an aggressive treatment course of topical antibiotics and corticosteroids and after demonstrating an inability to tolerate oral antibiotics, the patient was treated with supratarsal subconjunctival injections of vancomycin and triamcinolone, followed by repeated sweepings of the conjunctival fornices with 10% povidone-iodine on a cotton swab. The patient's symptoms improved dramatically after the antibiotic and corticosteroid injections and ultimately resolved completely after multiple povidone-iodine sweepings.
In patients with giant fornix syndrome who are recalcitrant to or intolerant of aggressive topical and systemic therapy, supratarsal subconjunctival injections of antibiotics and corticosteroids and sweeping of the conjunctival fornices with povidone-iodine are 2 local treatments which may be useful in eradicating the infection.
From the *Department of Ophthalmology and †Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA; and ‡Department of Ophthalmology, San Francisco General Hospital, San Francisco, CA.
Received for publication March 29, 2010; revision received June 7, 2010; accepted June 20, 2010.
J. B. Taylor and R. E. Fintelmann have contributed equally to the article and both qualify for first authorship.
The authors state that they have no financial interest in the products or techniques described in this article.
Reprints: Bennie H. Jeng, Department of Ophthalmology, University of California San Francisco, 10 Koret Way, K-304, San Francisco, CA 94143-0730 (e-mail: firstname.lastname@example.org).