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Eye infectionsKristine Krafts, M.D. | March 7, 2008
EYE INFECTIONS | outline
• Introduction
• Eyelid
• Conjunctiva
• Cornea
• Orbit
EYE INFECTIONS | outline
• Introduction
x
• Anatomy
• Age
• Bug
• Not always a bug!
INTRODUCTION | how to think about eye infections
• Look at conjunctiva, sclera
• Check for exudate
• Slit lamp exam
• Corneal scrapings
• Special eye samples
• Serology, blood cultures
INTRODUCTION | how to make a diagnosis
Slitlamp exam
Slitlamp exam
EYE INFECTIONS | outline
• Introduction
• Eyelid
• Common!
• Clogged meibomian glands
• Chronically dry, gritty eyes
• Treatment: warm packs, lid scrubs, artificial tears, maybe erythromycin or doxycycline
EYELID | blepharitis
Inflamed meibomian glands
Blepharitis
Blepharitis
Chalazion
• S. aureus, P. acnes
• Infection of glands at eyelid base
• Hot packs
EYELID | sty
Sty
EYE INFECTIONS | outline
• Introduction
• Eyelid
• Conjunctiva
• Viral
• Most common
• Swollen nodes, watery
• Bacterial
• Most dangerous
• Pus
• Allergic
• Most annoying
• Watery, itchy
CONJUNCTIVA | conjunctivitis
• Half of cases of adult conjunctivitis
• Adenovirus (common cold)
• Preauricular nodes
• Watery discharge
• Follicles
• Treatment: good hygiene
CONJUNCTIVA | conjunctivitis
Viral conjunctivitis
Viral Conjunctivitis
Viral conjunctivitis
Follicles
• Most cases of childhood conjunctivitis
• Mucopurulent discharge
• Papillae
• Treatment: erythromycin (most cases)
CONJUNCTIVA | conjunctivitis
Bacterial conjunctivitis
Papillae
Bacterial conjunctivitis
• Most common bugs:
• H. influenzae
• S. pneumoniae
• S. aureus
• Dangerous bugs:
• N. gonorrhoeae
• C. trachomatis
CONJUNCTIVA | conjunctivitis
Neisseria gonorrhoeae
• Newborns, sexually active adults
• Abundant, purulent discharge
• Aggressive! Corneal perforation within days
• Need IV antibiotics
• Prevent with silver nitrate, erythromycin
CONJUNCTIVA | conjunctivitis
Neonatal conjunctivitis caused by Neisseria
• Third-world countries, crowded conditions
• Chlamydia trachomatis A-C
• Chronic, scarring infection
• Untreated, leads to blindness
CONJUNCTIVA | conjunctivitis
Chlamydia: Trachoma
Trachoma
Trachoma
Trachoma: Corneal scarring
• Newborns, sexually active adults
• Chlamydia trachomatis D-K
• Onset: 5-14 days
• Mucopurulent discharge
• Milder than trachoma, but still risk of corneal damage
Chlamydia: Inclusion Conjunctivitis
CONJUNCTIVA | conjunctivitis
• Itching
• Swelling
• “allergic shiners”
• chemosis
• Treatment: antihistamines
Allergic conjunctivitis
CONJUNCTIVA | conjunctivitis
Allergic conjunctivitis
Allergic conjunctivitis
EYE INFECTIONS | outline
• Introduction
• Orbit
• Eyelid
• Conjunctiva
• Cornea
• Abrasion vs. ulceration
• Trauma, contacts
• P. aeurginosa, Aspergillus
• Danger: corneal thinning, rupture
• Another danger: leaky anterior chamber vessels, hypopyon, adhesions, increased intraorbital pressure, blindness
CORNEA | abrasion and ulceration
Corneal trauma
Corneal ulcer and hypopyon
Aspergillus
Herpes keratitis
Herpes keratitis: dendritic lesion
• Involves skin
• Trauma, insect bite, URI spread
• S. aureus, S. pyogenes
• Vision normal
• Treatment: antibiotics, close follow-up
ORBIT | cellulitis
Periorbital (preseptal) cellulitis
• Involves deep tissues
• Extension from sinuses
• S. pneumo, fungi (uncommon)
• Proptosis, decreased motility, decreased vision
• Treatment: IV antibiotics, surgery
ORBIT | cellulitis
Orbital (postseptal) cellulitis
Periorbital cellulitis
Orbital cellulitis
CT scan: unilateral proptosis
CT scan: sinus infection extending into orbit
Branching hyphae in necrotic sinus tissue
Branching hyphae invading vessel
Severe case of mucormycosis
EYE INFECTIONS | summary
• Eyelid – Blepharitis
• Conjunctivis – three kinds
• Cornea – abrasion vs. ulceration
• Orbit – preseptal vs. postseptal cellulitis