This document provides a comprehensive overview of eye anatomy, normal flora, and various eye infections, including conjunctivitis, keratitis, endophthalmitis, and periocular infections. It details clinical manifestations, routes of infection, and management or treatment options for different types of ocular conditions. Emphasis is placed on the importance of diagnosis and the methods used to evaluate eye infections, alongside common organisms involved.

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