Eye infections Kristine Krafts, M.D. | March 7, 2008

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