Infections
Infections – Cornea & Conjunctiva
What is conjunctivitis?
Commonly known as Pink Eye, conjunctivitis is an infection of the conjunctiva (the inside of the eyelid). It can be caused by bacteria, virus or allergies (see the Allergy section)
Signs and symptoms:
Red, irritated, watery eyes with a burning and scratchy feeling. May have pus or watery discharge.
Preventing the spread of the infection:
Pink Eye spreads very easily. Wash hands before and after using the medicine in your eye. Wash any clothes, towels, pillow cases touched by the infected eye. Avoid sharing cosmetics.
Treatment:
See your eye care specialist. Usually an antibiotic will be selected by your eye care specialist
Bacterial Keratitis (Corneal Ulcer)
What is bacterial Keratitis (Corneal ulcer)?
A corneal ulcer is an infection of the cornea by bacteria, viruses or fungi. Two of the common causes are: Abrasion of the cornea with foreign bodies and poor hygiene of contact lenses (especially if worn overnight).
Signs and symptoms
Eye pain, redness, itching and burning, white patch on the cornea, increased tearing, sensitivity to light (photophobia).
Preventing the spread of the infection
Early attention by an ophthalmologist or optometrist to any eye infection may prevent the ulceration and further injury to the cornea. An untreated corneal ulcer can permanently damage the cornea. It may also perforate the eye, resulting in a spread of infection, increasing the risk of permanent visual impairment.
Treatment
See your eye care specialist. Usually an antibiotic will be selected by your eye care specialist
Chlamydial & Gonococcal Conjunctivitis
What is Chlamydial conjunctivitis?
An infection of the inner lid which typically affects sexually active teens and young adults. Chlamydia is considered one of the major sexually transmitted pathogens. Women seem to be more susceptible than men. This infection also affects infants whose mothers have untreated chlamydial conjunctivitis The incidence of infection seems to be directly related to sexual activity.
Sign and symptoms
Persistent eye infection (3 weeks or more) with common mucus discharge.
Systemically, signs and symptoms may include a history of vaginitis, pelvic inflammatory disease or urethritis.
Ocular signs and symptoms include the chief complaint that an eye infection has persisted for over three weeks despite treatment with topical antibiotics. Mucus discharge is common.
What is Gonococcal conjunctivitis?
Also a sexually transmitted ocular disease. Even casual interaction with infected individuals has been reported as a cause. Newborn infants may acquire the infection by passing through an infected birth canal. This is a very contagious ocular disease.
Signs and symptoms
Red eye with foreign body sensation. The eye may be shut with substantial pus discharge. The incubation period is generally two to seven days.
Preventing the spread of the infection
The transmission to the eye can result from hand contact from a site of genital infection to the eye. Infected pregnant mothers can infect the newborn. Avoid sharing cosmetics.
Treatment
See your eye care specialist
Usually an antibiotic will be selected by your eye care specialist.
Bacterial Infections
What is blepharitis?
A common condition that causes inflammation of the eyelids.
Tends to recur.
Blepharitis occurs in two forms:
- Anterior blepharitis Posterior blepharitis
- affects the outside front of the eyelid, where the eyelashes are attached.
- two most common causes of anterior blepharitis are
- bacteria (Staphylococcus)
- scalp dandruff.
- affects the inner eyelid (the moist part that makes contact with the eye)
- caused by problems with the oil (meibomian) glands in this part of the eyelid.
- Two skin disorders can cause this form of blepharitis:
- acne rosacea, which leads to red and inflamed skin,
- scalp dandruff (seborrheic dermatitis).
What are the symptoms of blepharitis?
- dry eye
- foreign body
- burning sensation
- excessive tearing
- itching
- sensitivity to light (photophobia)
- red and swollen eyelids,
- redness of the eye
- crusting of the eyelashes on awakening.
What other conditions are associated with blepharitis?
Chalazion:
- painless firm lump caused by inflammation of the oil glands of the eyelid
Treatment
- involves keeping the lids clean and free of crusts.
- warm compresses should be applied to the lid to loosen the crusts, followed by a light scrubbing of the eyelid with a cotton swab and a mixture of water and baby shampoo.
- Patients who also have acne rosacea should have that condition treated at the same time.
Orbital Infections
Mucormycosis
- Mucormycosis is a fulminant oportunisitic fungal infection caused by fungi of the class Zygomycetes.
- PredisORALsing factors: patients who have diabetic ketoacidosis or who are immunocompromised
- Etiology: Infection begins in the paranasal sinuses and spreads to the orbit. The large, nonseptate hyphae cause vascular occlusion. This causes ischemia and infarction of tissue.
- Therapy: includes correction of the underlying metabolic abnormality and debridement of all involved infected tissue. It may require orbital and sinus exenteration, coupled with both systemic and local treatment with Amphotericin B
- Adjunct therapy: hyperbaric oxygen therapy may be beneficial
Orbital cellulitis
- infectious inflammatory process involving the orbital tissues posterior to the orbital septum and requires
- Etiologies include trauma, orbital fracture repair, strabismus surgery
- Extension of pre-existing infections of the face, lacrimal sac, and lacrimal gland which can extend into the orbit
- Pathophysiology: The most common bacterial pathogens in preseptal cellulitis include Haemophilus influenza, Staphylococcus aureus, and Streptococcus pneumoni
- Therapy: Subperiosteal abscess formation should be suspected if patients fail to improve or deteriorate on intravenous antibiotics .
- Infants with preseptal cellulitis are usually admitted for intravenous therapy, whereas
- older children and adults with preseptal infections may be treated with oral antibiotics. 7- to 10-days of intravenous therapy are required, followed by a course of oral antibiotics for 10 to 14 days
- infection posterior to orbital septum
- 90% from extension of acute or chronic bacterial sinusitis, remainder s/p trauma or surgery or 2o to extension from other orbital or periorbital infection, or endogenous w/septic embolization
- fever, proptosis, restriction of EOM’s, pain on globe movement
- decreased visual acuity Afferent Pupillary Defect (APD), prolonged high Intraocular pressure (IOP) can be indications for aggressive management to prevent orbital apex syndrome or cavernous sinus thrombosis
- CT of orbit and sinuses to confirm sinus disease, rule out mass, rule out orbital foreign body if h/o trauma (even remote), rule out orbital or subperiosteal abscess which will require surgical drainage
- blood culture then broad spectrum IV antibiotics to cover gram cocci, H. influenzae (although less prevalent in kids 2o to immunization), anaerobes, typically nafcillin and 3rd generation cephalosporin; ID consult if necessary; kids more often single organism
- progression of infection or no daily improvement on appropriate antibiotics can mean abscess: repeat CT as needed (prn) and drain w/concomitant sinus drainage as needed (prn)
- cavernous sinus thrombosis: rapid progression of proptosis and neurologic signs of intracranial dysfunction; may lead to meningitis; get neurosurgery consult
