ophthalmic common infections. introduction

eye infections

1. Eye infections
KIBET M.P
MSC MPE
BSC OPHTAL&CATR SURG
DIP CM & SURG

2. Anatomy

3. Anatomy

4. Anatomy
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.  

5. Anatomy
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.  

6. Anatomy
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.  

7. Anatomy
The posterior chamber is
the area behind the iris, but in front of the lens, that is
filled
with aqueous.  
The pupil is
the opening, or aperture, of the iris.  
The rectus medialis is
one of the six muscles of the eye.  
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.  
The sclera is
the white of the eye.  
The vein is
the vessel that carries blood away from the eye.  
The vitreous is
a transparent, colorless mass of soft, gelatinous material filling the
eyeball
behind the lens. 

8. anatomy
The
eyeball is protected anteriorly by the eyelids
And
contained in the orbit

9. Normal flora of the eye
Predorminant
organisms
Diphtheroids
S.epidermidis
Non
hemolytic strep

10. Eye infections
The
infections could be:-
Acute
Chronic
Primary
secondary

11. conjunctiva
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

12. conjunctiva
The
normal transparency may be lost
Papillae
may form especially in tarsal conjunctiva
Symptoms
include gritty eyes,photophobia,diminished vision and pain

13. organisms
Staph
epidermidis
Acinetobacter
Aeromonas
hydrophila
Peptostreptococcus
Bartonella
*
most common

18. conjunctivitis

19. Routes of entry
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

20. Determinants of infective
agents
Age-
neisseriae
/chlamydia-newborns
Children-
influenza,strep
pneumo,staph aureus
Young adults-
strep
pneumo,staph aureus/epidermidis

21. Management/control
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.

22. Cornea
Inflammation
of the cornea
Clinically
presents as loss of vision,,tearing,photophobia and
blepharospasm,ulceration
Symptoms-foreign
body sensation,pain

26. Organisms implicated
Gram
pos cocci- gram neg bacilli
*Staph
aureus .*pseudomonas
Staph
epidermidis . proteus
Strep
viridans .klebsiella
Strep
pyogenes .serratia
Strep
fecalis .E.coli
Peptostreptococcus
* most common
*Strep
pneumo

27. organisms
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

28. Routes of entry/predisposing
factors
Direct
penetration-organisms producing toxins/enzymes/virulent
factors-neisseria
Following
injury,eyelid abnormalities,tear dysfuntional states,corneal
anesthesia
Immunocompromised
states
Use
of contact lenses

29. Treatment
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??

30. Endophthalmitis
Most
cases develop after intraocular surgery-cataract surgery.
Organisms
involved-microflora
Clinically-decreased
visual acuity,pain,hypopion,hyperemia

34. organisms
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

35. Treatment
Is
according to culture and sensitivity
Iv
antibiotics-3G cephalosporins
Intravitreal
vancomycin-s.aureus
Sx-vitrectomy
Steroids??

36. Periocular infections
These
involve orbit and cellular adnexa
Principal
periocular structure susceptible to infections are eyelids ,the
components
of lacrimal apparatus and the orbit.

40. Eyelids
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

44. Eyelids
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

45. Lacrimal apparatus
Produce
the aqueous component of tear film
Canaliculitis-chronic
inflammation of canaliculi-by
propionibacterium,actinomyces
Dacrocystitis-inflammation
of lacrimal sac-
streppneumo,staphaureus,pseudomonas,chlamydia,h.influenza
in
children
Clinically-epiphora

46. Lacrimal app
Dacroadenitis-inflammation
of main lacrimal gland-
staph,strep,tuberculosis-chronic

49. Orbit and carvenous sinus
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,

50. causes
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

51. organisms
Staph
aureus
Strep
pyogenes
Strep
pneumo
Clostridia
H.influenza-<5s
Tb-hematogenous
spread

52. Clinical
Evidence
of trauma-bleedng,fever,lid edema and rhinorrhoea.
Pain,headache,loss
of vision
Tenderness,black
eye,proptosis

53. Treatment
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

54. treatment
Dacroadenitis-systemic
antibiotics
Cellulitis-cloxacillin,oxacillin,cephalexin
Clindamycin
for gram neg
Iv
antibiotics orbital cellulitis

55. Approach to diagnosis of eye
infections
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 aspiration- endophthalmitis

56. diagnosis
Gram
stain
ELISA
Dna/pcr-chlamydia
Fluorescent
microscopy
u/s,ct,MRI
for cellulitis

57. ANY
QUESTION FOR THE
FACULTY?
DANKE