Transcript Eye infections POSA

Ndonga T.A
Msc TID I
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The anterior chamber is the area bounded in front
by the cornea and in back by the lens, and filled
with aqueous.
The aqueous is a clear, watery solution in
the anterior and posterior chambers.
The artery is the vessel supplying blood to the
eye.
The canal of Schlemm is the passageway for the
aqueous fluid to leave the eye.
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The choroid , which carries blood vessels, is the inner
coat between the sclera and the retina .
The ciliary body is an unseen part of the iris , and
these together with the ora serrata form the uveal
tract.
The conjunctiva is a clear membrane covering the
white of the eye (sclera).
The cornea is a clear, transparent portion of the outer
coat of the eyeball through which light passes to the
lens.
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The iris gives our eyes color and it functions like the
aperture on a camera, enlarging in dim light and contracting
in bright light. The aperture itself is known as the pupil
The lens helps to focus light on the retina.
The macula is a small area in the retina that provides our
most central, acute vision.
The optic nerve conducts visual impulses to the brain from
the retina.
The ora serrata and the ciliary body form the uveal tract, an
unseen part of the iris.
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The posterior chamber is the area behind the iris, but in front of
the lens, that is filled with aqueous.
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The pupil is the opening, or aperture, of the iris.
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The rectus medialis is one of the six muscles of the eye.
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The retina is the innermost coat of the back of the eye, formed of
light-sensitive nerve endings that carry the visual impulse to the
optic nerve. The retina may be compared to the film of a camera.
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The sclera is the white of the eye.
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The vein is the vessel that carries blood away from the eye.
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The vitreous is a transparent, colorless mass of soft, gelatinous
material filling the eyeball behind the lens.
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The eyeball is protected anteriorly by the
eyelids
And contained in the orbit
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Predorminant organisms
Diphtheroids
S.epidermidis
Non hemolytic strep
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The infections could be:Acute
Chronic
Primary
secondary
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Conjunctivitis is the most common ocular
inflammation
Clinical manifestations-hyperemia,secretion –
due to exudates of inflammatory cells and
fibrin rich edematous fluid-which may be
purulent,mucopurulent,fibrinous or
serosanguinous depending on the cause.
When the exudate dries ,the eyelids stick
together
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The normal transparency may be lost
Papillae may form especially in tarsal
conjunctiva
Symptoms include gritty
eyes,photophobia,diminished vision and pain
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*Strep pneumo
. C.diphtheria
Strep pyogenes
.M.tuberculosis
strep viridians
.francisela
*Staph aureus
. T.pallidum
*H .influenza
.moraxella
*N.gonorrhoea/meningitidis
H.ducreyi
. shigella flexeneri
Proteus vulgaris
.Y.enterocolitica
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Staph epidermidis
Acinetobacter
Aeromonas hydrophila
Peptostreptococcus
Bartonella
* most common
conjunctivitis
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Routes of entry-hand to eye
-airborne formites
-contact with URTIs
-contact with genital tract
infections
-spread from adjacent
structures-face and
eyelids,sinuses
-Hematogenous spread -rare
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Age-neisseriae /chlamydia-newborns
Children-influenza,strep pneumo,staph aureus
Young adults-strep pneumo,staph
aureus/epidermidis
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Mostly self limiting
Px education-hand washing!
Rx-topical gentamicin/tobramycin-gram neg
Neomycin/polymixin-gram pos
Topical quinolones-severe infections
Parenteral ceftriaxone for gonococcal
Erythromycin syrup for chlamydia in
neonates/erythromycin ointment.
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Inflammation of the cornea
Clinically presents as loss of
vision,,tearing,photophobia and
blepharospasm,ulceration
Symptoms-foreign body sensation,pain
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Gram pos cocci*Staph aureus
Staph epidermidis
Strep viridans
Strep pyogenes
Strep fecalis
Peptostreptococcus
*Strep pneumo
gram neg bacilli
.*pseudomonas
. proteus
.klebsiella
.serratia
.E.coli
* most common
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Gram neg coccobacilli
gram-positive bacil
Moraxella
corynebacterium
Pasturella
c.tetani/c.perfringen
Morganella
bacillus cereus
Serratia
spirochetes
E.coli
treponema
Aeromonas
borrelia burgdoferi
mycobateria-tb,mac
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Direct penetration-organisms producing
toxins/enzymes/virulent factors-neisseria
Following injury,eyelid abnormalities,tear
dysfuntional states,corneal anesthesia
Immunocompromised states
Use of contact lenses
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Broad spectrum antibiotics used pending lab
results-cephalosporins +aminoglycosides
Aminoglycosides can be used synergistically
with ticarcillin.
Quinolones-pseudomonas and gram negatives
Use topical antibiotics
Parenteral-severe cases
Steroids??
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Most cases develop after intraocular surgerycataract surgery.
Organisms involved-microflora
Clinically-decreased visual
acuity,pain,hypopion,hyperemia
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Staph aureus
.E.coli
Staph epidermidis
.H.influenza
Strep pneumo
.klebsiella
Bacillus cereus
.moraxella
Corynebacteria spp
.proteus
Listeria
.pseudomonas
N.meningitidis
.s.typhimurium
Acinetobacter
.serratia
Enterobacter
.clostridium
Propiono bacterium acnes treponema pallidum
Actinomyctes israeli
.m.tuberculosis/leprae
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Is according to culture and sensitivity
Iv antibiotics-3G cephalosporins
Intravitreal vancomycin-s.aureus
Sx-vitrectomy
Steroids??
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These involve orbit and cellular adnexa
Principal periocular structure susceptible to
infections are eyelids ,the components of
lacrimal apparatus and the orbit.
Inflammation of the lid margins-blepharitis
 Often chronic and bilateral
 Two types-anterior-staphylococcal
-posterior-meibominitis
Organisms
Staphaureus,epidermidis,pseudomonas,proteus,
moraxella
.Mascara used has been implicated
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Erysipelas-acute cellulitis –strep
pyogenes,staph aureus-invasion of
subcutaneous after trauma
Hordeolum-internal/external depending on
glands involved-staph implicated
Internal-meibomian gland infection
External-stye infection of glands of zeis
sebaceous gland of eye lids
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Produce the aqueous component of tear film
Canaliculitis-chronic inflammation of
canaliculi-by propionibacterium,actinomyces
Dacrocystitis-inflammation of lacrimal sacstreppneumo,staphaureus,pseudomonas,chlam
ydia,h.influenza in children
Clinically-epiphora
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Dacroadenitis-inflammation of main lacrimal
gland-staph,strep,tuberculosis-chronic
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Cellulitis-pre septal anterior orbit septum and
post septal-orbital contents
Serious-loss of sight and spread to carvenous
sinus leading to thrombosis and death,
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Spread from contiguous structures like
sinuses,dental,intracranial infections
Direct innoculation after puncture wounds
Retained foreign bodies-sutures
After surgery
After fractures
Sequelae of dacrocystitis
Bacteremia in kids H.influenza,E.fecalis
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Staph aureus
Strep pyogenes
Strep pneumo
Clostridia
H.influenza-<5s
Tb-hematogenous spread
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Evidence of trauma-bleedng,fever,lid edema
and rhinorrhoea.
Pain,headache,loss of vision
Tenderness,black eye,proptosis
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Blepharitis-Topical –bacitracin,erthromycin
Steroids-reduce inflammation
Hordeolum-warm compresses and sytsemic
antibiotics if multiple or no response I&D if not
responding to rx
Canalliculitis-antibiotic irrigation with
penicillin G
Dacrocystitis-oral penicillin+warm compresses
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Dacroadenitis-systemic antibiotics
Cellulitis-cloxacillin,oxacillin,cephalexin
Clindamycin for gram neg
Iv antibiotics orbital cellulitis
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Mostly clinical diagnosis
Slit lamp examination
Swabs –conjunctiva, abscesses etc
Cultured on BA
Swab each anaesthetized eye separately
Can also do scrapings-cornea
Vitreous/aqueous humour aspirationendophthalmitis
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Gram stain
ELISA
Dna/pcr-chlamydia
Fluorescent microscopy
u/s,ct,MRI for cellulitis
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