Eye Infections

By Dr. Banumathi Gurusamy, HPP 1

EYE INFECTIONS

Dr. Banumathi Gurusamy

Hospital Pulau Pinang


Lid Infections• Stye (External Hordeolum)

- Suppurative inflamation of lash follicle and its associated gland of Zeis or Moll.

- Caused by Coagulase Possitive Staphylococcus.

Clinical features:

- Acute pain in the lid margin

- Tender inflamed swelling over the lid margin with pus pointing anteriorly through the skin


Stye


Stye- Treatment

• Warm compress.

• Antibiotics (systemic/ local).

• Surgical Incision & Curettage.


Internal Hordeolum

• Small Abscess caused by an acute Staphylococcal infection of meibomian gl.

• Clinical Features:

Tender inflamed swelling within tarsal plate.

More painful than stye.

Lesion enlarge & discharge pus either posteriorly through conjunctiva or anteriorly through skin.


Internal Hordeolum


Internal Hordeolum- Treatment

• Warm Compress.

• Antiobiotics ( Systemic/ Local).

• Surgical Incision & Curettage.


Chalazion (Meibomian Cyst)

• Chronic inflamatory lipogranulomatous lesion.• Clinical Features:

- Painless slowly enlarging firm lesion in the tarsal plate

- No signs of inflamation• Pathology:

Low grade infection

obstruction of ducts

Accumulation of meibomian secretion


Chalazion


Chalazion


Chalazion - Treatement

• Incision and Curettage

• Antibiotic ointment

• Complications:

Mechanical ptosis with Astigmatism

Int. Hordeolum

Rare – Meibomian Ca.


Chalazion - Treatement

Incision and Curettage


Blepharitis• Chronic inflamation of lid margin:

Staph. Blepharitis Seborrhoeic Blepharitis

• Clinical features:Irritation & burning sensation over lid marginBrittle scales clinging to the lashesTiny ulcerated areas (staph. Blepharitis)

• Treatment: Lid hygeineAntibiotic ointment Topical steroids


Blepharitis


Blepharitis



Orbital & Preseptal Cellulitis(more common in children)

Preseptal cellulitis: Infection of eye lids and soft tissue structures anterior to the orbital septum.

• Clinical features: Mild to moderate eye lids swelling Preceded by dental or sinus infections History of sharp or blunt trauma Ocular motility and pupilary reaction-

normal.• Treatment: Systemic antibiotics


Preseptal Cellulitis


Orbital Cellulitis

• Infection process posterior to the orbital septum that affects the orbital contents.

• Extension of infection from nasopharynx or paranasal sinuses- esp. Ethmoidal.

• Age group: Children & young adults

• Causative organisms- strep. Pneumoniae, Strep. Pyogenes, staph. Aureous, H. Influenzae (< 5 years).


Orbital Cellulitis (cont)

• Clinical features: Severe pain with marked swelling of the lids Conjuctival chemosis and congestion Proptosis of the globe Limitation of extraocular movements

with diplopia Impairment of pupillary reaction with

decreased vision.


Orbital Cellulitis- Complications

1. Cavernous sinus thrombosis.

2. Meningitis

3. Cerebral abscess

4. Central retinal artery occlusion

5. Optic nerve inflamation optic atrophyBlindness


Orbital Cellulitis


Orbital Cellulitis


Orbital cellulitis- Treatment

1. Investigations:

ESR, WBC

X-Ray paranasal sinuses

CT Scan

2. ENT referral

3. IV antibiotics

4. Drain the orbit as well as the infected sinuses.


Lacrimal System


Infection of Lacrimal System

Canaliculitis- infection of lacrimalcanaliculi

Chronic- caused by actinomyces israelii

Acute caused by herpes simplex infection or fungal infection. Eg: Candida

Treatment:

- Remove the obstructive concretions

- Treat with penicillin G. solution/ nystatin drops


Dacryocystitis (infection of lacrimal sac)

• Congenital- failure of canalisation of nasolacrimal duct.

• Clinical features: Epiphora Reflux of purulent materials when pressed over the medial canthus.

• Treatment:1. Hydrostatic massage2. Antibiotics3. Probing (6 months and 1 year)4. Surgery- Dacryocystorhinostomy


Dacryocytitis


Dacryocytitis- Adult onset

• Chronic Dacryocytitis

Middle age 75% female

• Predisposing factors:

Extreme deviated nasal septum.

Nasal polyp.

Hypertrophied inferior turbinates.

Trauma


Dacryocytitis- Adult onset (cont)

• Clinical features:

Epiphora

Regurgitation of mucous materials on pressure over medial canthus.

Syringing – blocked nasolacrimal duct.• Treatment:

Hydrostatic massage with repeated syringing.

Surgery- Dacryocystorhinostomy (DCR)


Acute Dacryocystitis

• Acute exacerbation of chronic Dacryocysitis• Clinical features:

Pain, redness and swelling over lacrimal sac area. Purulent discharge from the punctum Fever

• Treatment: Hot compress/ systemic antibiotic Aspirate the pus with wide bore needle,

(no I &D to avoid fistula formation.) Plan for DCR.






Acute Infectious Dacryoadenitis

• Infection of lacrimal gland.• Clinical features:

Pain, redness, swelling over the outer one third of the upper eye lid.

Common in young people. Caused by acute infection such as Staph.

or H. Influenzae Chronic infection as TB. Viral infection as mumps.

• Treatment- treat the causative factor.


Conjunctivitis

• Inflamation of conjunctiva.• Bacterial: Strepto. Pyogenes, pneumoniae.

Staph aureus.H. Influenzae.Gonococcus.

• Viral: Adenovirus, H. Simplex, H. Zoster• Trauma: Chemicals, ultraviolet rays• Allergic• Ophthalmia neonatorum- Neonates


Conjunctivitis- Clinical Features

• Usually bilateral.

• Conjunctival hyperaemia.

• Grittiness/ sandy sensation.

• Discharge with sticky eye lids.

• Severe cases- swollen eye lids with pseudomembrane formation.

• In Gonococcus conjuctivitis- swollen eye lids with copious purulent discharge.


Conjunctivitis


Conjunctivitis


Conjunctivitis - Ophthalmia neonatorum


Conjunctivitis


Conjunctivitis- Treatment

• Conjunctival swab for culture.

• Frequent local antibiotic/ systemic antibiotic.

• H. simplex- zovirax ointment

• Sodium cromoglycate drops with mild steroids allergic conjunctivitis.


Karatitis- inflamation of the cornea (corneal ulcer)

• Aetiology:

1. Bacteria: Staph., Strepto., Pseudomonas, Enterobacteriacea

2. Fungus: aspergillus, candida albicans

3. Viral: H. simplex, H. zoster

4. Acanthamoeba: in contact lense users.


Predisposing Factors

• Dry eye • Contact lens wear• Chronic infections of ocular adnexa• Epi. Defect-Trauma, chemical injury etc• Purulent conjunctivitis• Neurotrophic/ Exposure Keratopathy• Topical steroids, sys.immunosuppresive• Trauma


Symptoms & Signs

• Red eye• Mild to severe ocular

pain• Photophobia• Blurred vision• Eye discharge

• Conjunctival injec.• Focal white infiltrates

of corneal layers & stromal oedema

• Severe anterior chamber reaction with hypopyon

• Postr. synechiae


Diagnosis

• Corneal Scrapping for

1. Gramstain

2. KOH-mount

• Culture media

1. Blood agar

2. Chocolate agar

3. Sabouraud’s medium


Bacterial Keratitis• Staph.aureus and Strep.pneumoniae:

Produce oval yellow white densely opaque stromal lesion with surrounding relatively clear cornea

• Pseudomonas sp. : sharp ulceration with semiopaque ground glass appearance of adjacent stroma

• Enterobactriacea : shallow ulceration with diffuse stromal opalescence


Bacterial Keratitis

• Treatment

• Intensive anti-biotic drops with cycloplegics (to avoid synachieae formation and to relieve ciliary spasm.)

• Sub conjunctival injection if necessary


Bacterial Keratitis


Bacterial Keratitis


Bacterial Keratitis


Bacterial Keratitis


Fungal Keratitis

• Corneal lesion - Greyish white lesion with indistinct margin and delicate feathery finger like projections into adjacent stroma

• Multiple satellite small foci

• Overlying epithelium is elevated but intact


Fungal Keratitis


Fungal Keratitis


Fungal Keratitis (cont)

• Filamentous - Fusarium, aspergillus

• Non Filamentous - Candida albicans

• Treatment

• 1. Amphotericin-B eye drops

• 2. Fluconazole -1% aq. Solution

• 3. Ketaconazole

• 4. Iatroconazole

• Anti-fungal treatment - six weeks


Viral Keratitis (HSV)

• Caused by H.Simplex virus• Superficial punctate keratitis• Dendritic keratits(Thin linear branching

lesion with teminal bulbs at the end of each branch

• Geographic ulcer- large amoeba shaped ulcer with dendritic edges

• Corneal sensitivity- decreased• Stained with Rose Bengal dye


Viral Keratitis


Viral Keratitis (HSV)

• Treatment :

1. Topical Acyclovir with cycloplegic

2. Gentle debridement of the infected epi.as an adjunct to anti-viral agents

( anti-viral agents continued for seven to fourteen days then tapered over one week)


Viral Keratitis (HZV)

• Herpes Zoster virus.• Conjunctivits with corneal involvement

(multiple micro dendritis with uveitis).• Treatment : - oral Acyclovir

- preservative free artificial tears and lubricant oint.at night.






Acanthamoeba Keratitis

• Extremely painful stromal keratitis usually in a soft contact lens wearer who practices poor CL. hygiene

• Severe ocular pain, redness and photophobia over a period of several weeks.

• Early sign- less corneal and anterior segment inflammation than would be expected for the degree of pain


Acanthamoeba Keratitis (cont)

• Epithelial and sub-epithelial infiltrates

• Pseudo dendrites on epithelium

• Late sign-corneal stromal infiltrates in the shape of a ring

• Negative culture for bacteria & fungus

• Lack of response for the anti-biotic and anti-fungal therapy



Acanthamoeba Keratitis (cont)

• Treatment : Neosporin eye drops. Brolene 1 %(Propamidine isethionate). Chlorhexidine 0.002% eye drops. Oral anti-fungal therapy. Treatment continued for 6-8 weeks after the resolution of inflmn. which may take 18 months in some cases. Resistant cases- Keratoplasty.


Principles in the management (corneal ulcer)

• Primary therapy • Promotion of re- epithelialisation

- Lubrication-Artificial tears - Lid closure-Torsorrhaphy - Bandage soft contact lens

• Prevention of perforation - Tissue adhesive glue - Conjunctival flap to cover the thinned

out cornea


Principles in the management (cont)

• Ascorbate-in severe alkali burns to promote healing

• Severe non-responding cases need therapeutic penetrating keratoplasty

• Restoration of transparency: - Healed corneal ulcer with dense scarring - penetrating kerotoplasty • Non responding ulcers- lead to perferation or

endophthalmitis/ pan ophthalmitis- which needs evisceration


Endophthalmitis

• Intraocular inflamation of ocular cavities and their adjacent structures without extending beyond sclera.

Panophthalmitis

•Endophthalmitis + Involvement of sclera and tenons capsule extending into orbital tissues.


Endophthalmitis• Causes: Exogenous & Endogenous• Exogenous:

- Penetrating ocular trauma- Post op. complications (cataract & filtering operations).- Corneal ulcer

• Endogenous:- Septic emboli- bacterial endocarditis- Severe uveitis- immunocomp. Patients.- Toxoplasma chorioretinitis.- Spread of inf. From adjacent structures


Endophthalmitis• Clinical features:

Ciliary injection. Exudation in AC with hypopyon. Posterior synachiae. Posterior uveitis. Vitreous opacities/ choroiditis.

• Treatment: Vitreal tap for C & S and treat with

appropriate antibiotics.


Endophthalmitis


Anterior Uveitis (Iridocyclitis)Inflamation of uveal tract

• Symptoms:- Pain, unilateral red eye, photophobia and blurred vision.

• Signs:- Circumcorneal congestion.- Hazy anterior chamber with cells.- Severe inflamation hypopyon- Keratic precipitates on endothelium.- Constricted pupil with post. synachiae.


Anterior Uveitis (Iridocyclitis) (cont)

• Aetiology:

Exogenous- trauma etc.

Endogenous:

- Idiopathic

- Inf.- TB, candida, H.Zoster, Toxoplasmosis, Toxocara

- Associated with systemic diseases as

D.M, ankylosing spondylitis, sarcoidosis.


Anterior Uveitis (Iridocyclitis) (cont)

• Investigations:

ESR, RBS, Blood VDRL, Chest X-Ray,

X-Ray Sacroiliac joint.

• Treatment:

Steroids (local & systemic)

Mydriatics- to dilate pupil

Specific treatment to treat the cause


Anterior Uveitis


Anterior Uveitis


Thank You

End Of Presentation

Health & Medicine

Eye Infections