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Purpose : To report a case of delayed implant infection with Cutibacterium acnes ( C. acnes , previously known as Propionibacterium acnes ) 30 years after silicone sheet orbital floor implant. Methods : Case report with orbital imaging. Results : A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes . Conclusions : C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.

Corynebacterium amycolatum is a saprophyte gram-positive bacillus of the skin flora. It has been linked to diverse infections in immunocompromised patients and also of different types of prostheses. However, to our knowledge, there are no reports on its ability to produce ocular infections or to grow over alloplastic materials for orbital surgery. We present a case of orbital implant exposure including pure isolation of C. amycolatum. The patient was referred for discharge in his socket. After removal of the artificial eye, a large area of implant exposure and signs of chronic infection were observed. A microbiological sample was taken by rubbing the implant with a sterile swab. The sample was cultured and C. amycolatum was identified by phenotypical characterization. Other microbial species were not isolated. Besides being able to adhere to cardiac and joint devices, this case shows that C. amycolatum is a potential infectious agent of orbital prostheses. Pure isolation of C. amycolatum in an ocular sample is extremely rare and suggests an etiological role of this microorganism in an ocular or periocular infection.