Common ocular infections in Mulago Eye Department

2. Condition Statistic
Bacterial Conjuctivitis 64
Allergic conjuctivitis 174
Corneal ulcer 50
Periorbital cellulitis 7
Endophthalmitis 4
Herpetic infection -
HIV related 1
Uveitis 33
Retinitis 6
Dacryocystitis 9
Blepharitis 1

3. Condition Statistic
Bacterial conjuctivitis 163
Allergic conjuctivitis 392
Corneal ulcer 21
Periorbital cellulitis 15
Endophthalmitis
Herpetic infection
HIV related
Uveitis 19
Retinitis
Dacryocystitis 2
Blepharitis 1

4.  Conjuctivitis
 Corneal ulcers
 Periorbital and orbital cellulitis
 Endophthalmitis
 Herpetic infections
 HIV-related infections (CMV, Toxo)

6.  Adenoviruses and enteroviruses
 Associated with having a h/o cold or URTI or
being around someone who did
 Usually a course of 1-2 weeks of tearing,
pain, itchiness and redness
 Diffuse injection, chemosis, follicles, mucus
discharge, tarsal conjuctival petechiae or
hemorrhages, cervical adenopathy
 Corneal involvement in EKC

12.  Contagious as long as they are clinically
affected (symptomatic)
 Handwashing frequently for prevention and
avoid shaking people’s hands
 Rx: mainly benign; self-limiting:
-cold compresses
-artificial tears
Avoid touching fellow eye
GPs to avoid giving topical steroids

13.  Very similar to viral in ppt.
-itch>pain; chemosis>injection
-h/o exposure to allergens
-more symmetric than viral (unless only eye
exposed)
Rx:
-Cold compresses
-artificial tears
-Alacot (olopatadine) BD
-avoid steroids and vasoconstrictors as primary
care.

16.  Usually in children
 Etiology: S. aureus, S. pyogenes,
Pneumococcus
 Obvious purulent discharge
 Rx: erythromycin or polysporin ointment QID
for 1-2 weeks based on clinical course

17.  Neisseria gonorrhoeae: very rapidly
proliferating. Can penetrate intact corneal
epithelium hence corneal perforation.
 Occurs in neonates; and sexually active
persons
 Purulent and hyperacute course; severe
pain; preauricular adenopathy
 Ix: g.s, GNC
 Rx: I.M Ceftriaxone + topical bacitracin

19.  Culture if symptoms persist > 1 month
 Can be related to blepharitis (staph; strep);
Eyelid hygiene; bacitracin ointment; warm
compresses; artificial tears
-can be due to lacrimal system (ask h/o tearing.
Press on lacrimal sac)
-can be due to chlamydia.
Trachoma, adult inclusion conjuctivitis

20.  Different serotypes (D-K) of C. trachomatis
 Contact of eye with infected secretions
(swimming pool, genitourinary secretions)
 Preauricular nodes; less severe and more
chronic than adenoviral conjuctivitis
 Rx: oral doxy X 2 wks

25.  Caused by serotypes, A, B, C of C. trachomatis
 Trachoma endemic in India, Indochina, Africa,
Middle East
 Transmitted by fomites and contact with
secretions
 Superior tarsal follicles, limbal follicles, pannus,
conjuctival scarring
 Cicatrization causes blindness
 Rx: Doxy 100 BID X 2 wks or po erythro for kids
and women who are pregnant or nursing.

27.  C. trachomatis: 5-14 days post partum,
mucopurulent discharge and severe papillary
reaction, culture; Rx: oral eryth (50mg.kg.d
QID x 2 wks)
 HSV
 Silver nitrate toxicity (within 1 day
postpartum)
 Gonorrhea (1-3 days postpartum)

29.  Superficial skin infection of eyelid(s) and
surrounding area
 Staph. aureus, strep. Pneumoniae, strep.
Pyogenes, H.flu waning after vaccine
 Dacryocystitis; infected lacrimal sac (tender,
hot, tearing problems)
 Stye; acute inflammation of the sebaceous
gland of an eyelash

30.  Rx: oral augmentin, ceftin or keflex,
-warm compresses for dacryosystitis and styes
-refer to oculoplastics for lacrimal problems
 Look out for orbital cellulitis signs
 If any suspicion of orbital disease; admit pt,
I.V abx

32.  Orbital cellulitis is more severe and more
threatening because it can damage the optic nerve
; and muscles surrounding the eye
 Infection behind the septum spreads rapidly in orbit
 Clinical signs of orbital compartment syndrome
include:
-Proptosis
-Decreased vision
-RAPD
-Decreased colour vision
-Restricted or painful motility

34.  Ix: CT scan
 Rx: I.V abx + surgical evaluation
-sinus evaluation is warranted
-for DM pts or acidosis or ISS, high risk of the
orbital cellulitis is being caused by mucor.
Rx: -surgical debridement
–I.V Amphotericin
–Treat acidosis
 Close follow-up is vital

41.  Corneal infections can occur from a variety
of pathogens
 Bacteria that can penetrate intact corneal
epithelium:
-N. gonorrhea
–Pseudomonas
–C. diphtheriae
-Listeria

42.  One of the biggest risk factors for corneal
infections is contact lenses:
-block oxygen supply to the cornea
-mechanically rub against cornea
-provide a base for bacteria to grow
-cornea is naturally avascular and thus
vulnerable

45.  Corneal ulcers=epithelial defect + infiltrate
-staph, strep, gram-negatives
–pseudomonas especially in contact lens
patients
Contact lenses can cause just abrasion or SPK
or even corneal ulcer.
-If just SPK;
Rx= Fluorouinolone ED QID

46.  C/O: -severe pain, pain worsened on
blinking,-photophobia –variable change in
vision –mucopurulent discharge
 O/E: Corneal opacities (white) with epithelial
defects
 RX: Fluoroquinolone q.1hr
 Early referral to ophthalmologist
 If refractory; go to Cefazolin + Tobra q.1hr

47.  Unusual hx
 Refractory to rx
 Monocular
 Lesion >3X3mm
 Anterior chamber reaction
 Central lesion
 If h/o MRSA; go to vanco drops
 If animal scratch; consider po augmentin

48.  Very common in Africa; agric culture
 Chronic
RFs:
-h/o organic material
–ISS
–steroids
Etiology: -candida –aspergillus –fusarium

49. O/E:
 -featherly (irregular) borders
 –satellite lesions
 –hypopyon
 –endothelial plaque
 Ix: culture, AC tap or biopsy
 Rx: Topically: Amphotericin, Natamycin,
Voriconazole

52.  Causes:
- blepharitis
- –conjuctivitis
- –keratitis
- –iridocyclitis
- –trabeculitis
- –retinitis

53.  Ask about previous herpes elsewhere
 Can present concurrently with other areas of
herpes; as reactivation of old lesions, or as lesions
refractory to antibacterials
Reactivation occurs with:
 -sun exposure,
 stress,
 fever,
 menses,
 cold wind,
 ISS,
 minor trauma

59.  Skin/lids: vesicles on erythematous base
 Conjuctiva: watery discharge, fluorescein or
rose bengal staining on conjuctiva
 Cornea: Punctate staining that progresses to
dendritic epithelial defects and infiltrates –
decreased corneal sensation (esp. chronic) –
stromal melting –pure stromal keratitis w/o epi.
Defect (immune).
 Iritis and trabeculitis: increased IOP,
photophobia

60. Rx:
 Blepharitis: Viroptic 5 x/d + ACV 400 5x/d
 Conjuctivitis: Viroptic 9 x/d
 Epi defect:
-debridement
–Viroptic 9x/d and Fluoroquinolone BID oral
acyclovir not needed. Alt: vidarabine
 Melt: glue, provera, doxy, bandage contact lens,
tarsorrhaphy, lubrication, cycloplegia, Viroptic
5x/d.

61.  Stromal keratitis:
-Viroptic 5x/d + mild steroids (drop latter if any
epi. defect)
 Iridocyclitis:
-steroids
-oral acyclovir
-cycloplegia
Trabeculitis: glaucoma meds, steroids

62.  Chicken pox rarely involves eye (limbal
papulovesicles)
–lesions self-limited, can give Vira-A ointment 5x/d
 Herpes Zoster Ophthalmicus (HZO)
–Shingles usually involves V1, eye often
affected;
-Hutchinson sign: vesicles on tip of nose means
cornea involved

63.  Skin involvement presents as dermatomal
vesicles, erythema (respects midline)
 Ocular involvement presents with:
-conjuctivitis
–scleritis
–keratitis (pseudodendrites with stuck-on
appearances)
–decreased corneal sensation; ulcers

65.  For HZO without ocular involvement:
-oral ACV 800mg 5x/d
–Famciclovir 500mg TID
–Valacyclovir 1gm BID
–more rapid healing, less post herpetic
neuralgia if started within 3 days (72 days)
-topical antibiotics to skin vs. superinfection

66.  For HZO with ocular involvement:
-topical ophthalmic antibacterials
–debridements
–topical antiviral therapy not proven to be of
benefit (if suspicion of HSV; start Viroptic)
–systemic antivirals as before
ISS (HIV, leukemia): I.V acyclovir 10mg/kg
8hourly

67.  Post herpetic neuralgia:
-antidepressants
–capsaicin cream
–tegretol
–gabapentin
 Exposure keratopathy:
 -lubrication
 –bandage contact lens
 –punctal plug if necessary

68.  Defn: infection of inner structures of the eye
 Devastating event
 RFs:
-intraocular surgeries (62%)
–penetrating trauma
–glaucoma surgery
–endogenous can occur early or long after
surgery

69.  C/O: Deep pain, redness, visual loss after
surgery
 O/E: Injection, cells, hypopyon, loss of red
reflex, corneal clouding
 RX: I.V abx, intravitreal abx, vitrectomy in
select cases

70.  Early: S –S. epi (40%), S. aureus (20%),
strep (20%)
 Late: propionibacterium
 Trauma: bacillus
 Blebs: pneumococcus, H. influenza
 Endogenous: fungi are majority staph,strep,
H.flu –ISS/DM/TPN/IVDA/prosthetic
valves/meningitis/endocarditis/UTI

71.  Cotton-wool spots
 CMV retinitis
 VZV (ARN)
 Toxoplasmosis
 Syphilis
 MAC
 Cryptococcus
 P.carinii