Eye Infection

Microbiology and Parasitology | Lecture | Finals

BSN 1H | PROF. Charlotte Lejat | SEM 2 2022-2023
● Sclera - is the white of the eye
● Vein - is the vessel that carries blood away
Eye Infection
from the eye
● Vitreous - is a transparent, colorless mass
Anatomy of the Eye of soft, gelatinous material filling the eyeball
● Anterior Chamber - is the area bounded in behind the lens
front by the cornea and in back by the lens, The eyeball is protected anteriority by the
and filled with aqueous. eyelids and contained in the orbit
● Aqueous - is a clear, watery solution in the
anterior and posterior chamber. Normal Flora of the Eye
● Artery - is the vessel supplying blood to the ● Predominant organisms
eye ● Diphtheroids
● Canal of Schlemm - is the passageway for ● S. Epidermidis
the aqueous fluid to leave the eye ● Non Hemolytic Strep
● Choroid - which carries blood vessels, is
the inner coat between the sclera and the Eye Infection
retina. ● The infectious could be:
● Ciliary body - is an unseen part of the iris, - Acute - less than 6 months
and these together with the ora serrata from - Chronic - continued presence of
the uveal tract. the virus or organism. Current and
● Conjunctiva - is a clear membrane recurrent disease. Prolonged
covering the white if the eye (sclera) incubation period
● Cornea - is a clear, transparent portion of - Primary - the first time that you are
the outer coat of the eyeball through which exposed to an infected pathogen
light passes to the lens - Secondary - caused by the
● Iris - gives our eyes color and it functions treatment. E.g Vaginal Bacteriosis
like the aperture on a camera, enlarging in
dim light and contracting in bright light. The
aperture itself is known as the pupil Conjunctiva
● Lens - helps to focus light on the retina - Conjunctivitis is the most common ocular
● Macula - is a small area in the retina that inflammation
provides our most central, acute vision. - Clinical Manifestation - hyperemia
● Optic Nerve - conducts visual impulses to Secretion - due to exudates of
the brain from the retina inflammatory cells and fibrin rich edematous
● Ora Serrata - and the ciliary body from the fluid- which may be purulent, mucopurulent,
uveal tract, an unseen part of the iris fibrinous or serosanguinous depending on
● Posterior Chamber - is the area behind the the cause.
iris, but in front of the lens, that is filled with - When the exudate dries, the eyelids stick
aqueous together
● Pupil - is the opening, or aperture of the iris. - The normal transparency may be lost
● Rectus Medialis - ia one of the six muscle - Papillae may form especially in tarsal
of the eye conjunctiva
● Retina - is the innermost coat of the back - Symptoms include gritty eyes,
of the eye, formed of light-sensitive nerve photophobia, diminished vision and pain
endings that carry the visual impulse to the Organism Implicated
optic nerve. The retina may be compare to
- Strep Pneumo
the film of a camera
Eye Infection
Microbiology and Parasitology | Lecture | Finals
BSN 1H | PROF. Charlotte Lejat | SEM 2 2022-2023
- Strep Pyogenes
- Strep Viridians Management/Control
- Staph Aureus
- H. Influenza - Mostly self-limiting
- N. Gonorhoea/Meningitidis - Px education - hand washing!
- H.Ducreyi - RX- topical gentamicin
- Proteus Vulgaris - Tobramycin - gram negative
- C. Diphtheria
- M. Tuberculusis - Neomycin/polymyxin - gram pos
- T. Pallidium - Topical quinolones - severe infections
- Moraxella - Parenteral ceftriaxone for gonococcal
- Shigella Flexeneri
- Y. Enterocolitica - Erythromycin syrup for chlamydia in
- Staph epidermidis neonates/ erythromycin ointment
- Acinetobcter
- Aeromonas hydrophila
- Peptostreptococcus
- Bastonella Cornea
Normal Eye - in a healthy eye, the sclera is - Inflammation of the cornea
essentially white with only a few small blood - Keratitis - inflammation of the cornea
vessels visible. There is an adequate tear film, with
no significant discharge or watering. - Loss of vision, tearing, photophobia and
blepharospasm, ulceration
Bacterial Conjunctivitis - a red eye with a sticky - Symptoms - foreign body sensation, pain
yellow or yellow/green discharge. Eyelids may be
Organisms Implicated
stuck together upon waking. Can affect one or both
eyes. Usually spread by direct contact only. - Gram pos cocci-
- gram neg bacilli
Viral Conjunctivitis - the type of conjunctivitis - Staph aureus
most commonly associated with the term “pink
eye”. Appearance: red, itchy, watery eye. Can affect - pseudomonas
one or both eyes. Highly Contagious. - Staph epidermidis
- proteus
Allergic Conjunctivitis - very similar in
appearance to viral conjunctivitis, but accompanied - Strep viridans
by nasal congestion, sneezing, eyelid swelling and - klebsiella
sensitivity to light. Both eyes are affected. Not - Strep pyogenes
Contagious.
- serratia
Routes of Entry
- Strep faecalis
- Hand to eye
- E.coli
- Airborne fomites
- Peptostreptococcus
- URTI’s
- most common
- Contact with genital tract infections
- Strep pneumo
- Spread from adjacent structures: face and
- Gram neg coccobacilli
eyelids and sinuses
- gram-positive bacilli
- Hematogenous Spread - Rare
- Moraxella
- Corynebacterium
Determinant of Infective Agents
- Pasteurella
- Age - neisseria
- c.tetani/c.perfringens
- Newborns - Chlamydia
- Morganella
- Children - influenza, strep pneumo, staph
- bacillus cereus
aureus
- Serratia
- Young Adults - strep pneumo,
- spirochetes
aureus/epidermidis
- E.coli
Eye Infection
Microbiology and Parasitology | Lecture | Finals
BSN 1H | PROF. Charlotte Lejat | SEM 2 2022-2023
- Treponema - serratia
- Aeromonas - Enterobacter
- borrelia burgdorferi - clostridium
- mycobacteria-tb,mac - Propionibacterium acnes
- treponema pallidum
Routes of entry/predisposing factors - Actinomyces israeli
- Direct penetration - organisms producing - m.tuberculosis/leprae
toxins/enzymes/virulence factors-neisseria Treatment
- Following injury, eyelid abnormalities, tear - Is according to culture and sensitivity
dysfunctional states, corneas anesthesia - IV antibiotics - 3G cephalosporins
- Immunocompromised states - Intravitreal vancomycin - s. Aureus
- Use of contact lenses - Steroids

Treatment
Periocular Infections
- Broad spectrum antibiotics used of pending
lab results-cephalosporins + - These involves orbit and cellular adnexa
aminoglycosides - Principal Periocular structure susceptible to
- Aminoglycosides can be used infectionns are eyelids, the components of
synergistically with ticarcillin. lacrimal apparatus and the orbit
- Quinolones - pseudomonas and gram
negatives Eyelids
- Parental - severe cases
- Blepharitis - inflammation of the lid margins
- Steroids
- Often chronic and bilateral
- Two types- anterior-staphylococcal
Endophthalmitis Posterior - meibomitis
- Most cases develop after intraocular Organisms
surgery-cataract surgery - Staph aureus
- Organisms involved-microflora - Epidermidis
- Clinically-decrease visual acuity, pian, - Pseudomonas
hypopion, hyperemia - Proteus
Organisms - moraxella
- Staph aureus - .Mascara used has been implicated
- E.coli Erysipelas - acute - cellulitis - strep pyogenes,
- Staph epidermidis staph aureus-invasion of subcutaneous after
- H.influenza trauma
- Strep pneumo . Hordeolum - internal/external depending on glands
- Klebsiella involved-staph implicated
- Bacillus cereus Internal - meibomian gland infection
- Moraxella External - stye infection of glands of zeis
- Corynebacterium spp sebaceous gland of eye lids
- proteus
Listeria
- pseudomonas
- N.meningitidis Lacrimal Apparatus
- s.typhimurium
- Acinetobacter
Eye Infection
Microbiology and Parasitology | Lecture | Finals
BSN 1H | PROF. Charlotte Lejat | SEM 2 2022-2023
- Produce the aqueous component of tear - Hordeolum - warm compresses and
film systemic antibiotics if multiple or no
- Canaliculitis - chronic inflammation of response I and D if not responding to rx
canaliculi-by propionibacterium, - Canaliculitis - antibiotic irrigation with
actinomyces penicillin G
- Dacryocystitis - inflammation of lacrimal - Dacrocystitis - oral penicillin + warm
sac-strep pneumo, staph aureus, compresses
pseudomonas, chlamydia, h. Influenza in - Dacryoadenitis - systemic antibiotics
children - Cellulitis - cloxacillin, oxacillin, cephalexin
- Clinically - epiphora - Clindamycin for gram negative
- Dacryoadenitis - inflammation of main - Iv antibiotics orbital cellulitis
lacrimal gland-staph, strep, Approach to diagnosis of eye infections
tuberculosis-chronic - Most clinical diagnosis
- Slit lamp examination
- Swabs - conjunctiva, abscesses etc
Orbit and Cavernous Sinus
- Culture BA
- Cellulitis - pre septal anterior orbital - Swab each anesthetized are separately
septum and post septal-orbital contents - Can also scrapings-cornea
- Serious-loss of sight and spread to - Vitreous/aqueous humour
cavernous sinus leading to thrombosis and aspirations-endophthalmitis
death Diagnosis
Causes - Gram stain
- Spread from the contagious structures like - ELISA
sinuses, dental, intracranial infections DNA/PCR - chlamydia
- Direct inoculation after puncture wounds - Fluorescent microscopy
- Retained foreign bodies- sutures - U/S, ct, MRI for cellulitis
- After surgery
- After Fractures
- Sequelae of dacryocystitis
- Bacteremia in kidsH. Influenza, E. faecalis
Organism
- Staph aureus
- Strep pyogenes
- Strep pneumo
- Clostridia
- H.influenza-<5s
- Tb-hematogenous spread
Clinical
- Evidence of trauma-bleeding fecer, lid
edema and rhinorrhoea
- Pain, headache, loss of vision
- Tenderness, black eye, proptosis
Treatment
- Blepharitis - topical - bacitracin,
erthromycin
- Steroids - reduce inflammation