1887

Chapter 14 : Ocular Infections

Authors: Irina S. Barequet1, Ann Sullivan Baker3,†, Oliver D. Schein5
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Affiliations: 1: Cornea and Anterior Segment Service, Wilnier Eye Institute, Johns Hopkins University, Baltimore, MD 21287; 2: Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 52621, Israel; 3: Infections Disease Service, Massachusetts Eye and Ear Infirmary, and Massachusetts General Hospital, Boston, MA 02114; 4: Harvard Medical School, Boston, MA 02115; 5: Cornea and Anterior Segment Service, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287
Content Type: Monograph
Publication Year: 2000

Category: Clinical Microbiology

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Abstract:

Ocular infections attributed to foreign bodies may be categorized by the anatomic location of the infection. This chapter concentrates on microbial keratitis secondary to contact-lens use and endophthalmitis after surgical or traumatic perforation of the eye. Foreign-body-associated lid and orbit infections are mainly secondary to trauma. The diameter and configuration of the infection, its relationship to the visual axis, its depth in the cornea, and the presence of associated eye conditions should be noted, and if possible, photography should be performed. Corneal scrapings for cultures are required for precise microbiologic diagnosis. The overwhelming risk factor for microbial keratitis among lens wearers is overnight wear. Given current contact-lens technology, the most effective way to reduce the incidence of infections is to discourage overnight wear of lenses. Any contact-lens-wearing subject who experiences the acute onset of ocular pain, decreased vision, and a red eye should remove the lens and seek ophthalmologic attention promptly. As opposed to infections in contact with a prosthesis elsewhere in the body that usually require removal of the prosthesis for sterilization, in cases of acute endophthalmitis following cataract surgery there is no evidence to support the notion that the intraocular lens (IOL) should be removed. Oral fluconazole (800 mg or more) may be efficacious as a long-term follow-up antibiotic for . Some surgeons add antibiotic (e.g., vancomycin) to the intraocular injected solutions used during cataract surgery.

Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
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Ocular Infections
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Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
/content/10.1128/9781555818067.chap14.fig14-1
Figure 1

Schematic illustration of a sagittally sectioned anterior segment containing cilia-fixated posterior chamber lens. The loops course in front of the peripheral flaps of the anterior capsule and insert into the angle or groove formed by the junction of the iris root and the ciliary body.

10.1128/9781555818067/fig14-1_thmb.gif
10.1128/9781555818067/fig14-1.gif
Image of Figure 1
Figure 1

Schematic illustration of a sagittally sectioned anterior segment containing cilia-fixated posterior chamber lens. The loops course in front of the peripheral flaps of the anterior capsule and insert into the angle or groove formed by the junction of the iris root and the ciliary body.

Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
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Figure 2

Photomicrograph of the capsular sac removed from the eye of a 71-year-old patient implanted with a posterior chamber lens who was well for 6 months until posterior capsular opacification developed. An Nd:YAG laser capsulotomy was performed. After this procedure, the eye developed a severe, diffuse inflammation diagnosed as probably endophthalmitis. The intraocular lens and the lens capsular sac were removed. Note the portion of the lens capsule (arrows) and the fibrous metaplasia (F) of the residual lens cortex. The lightly stained material is residual necrotic lens substance. The deeply stained basophilic material (B) at the left is gram positive and represents necrotic organisms. (Gram stain; original magnification, ×30. Courtesy of Francis W. Price, Jr., Indianapolis, Ind. Reprinted with permission [ ].)

10.1128/9781555818067/fig14-2_thmb.gif
10.1128/9781555818067/fig14-2.gif
Image of Figure 2
Figure 2

Photomicrograph of the capsular sac removed from the eye of a 71-year-old patient implanted with a posterior chamber lens who was well for 6 months until posterior capsular opacification developed. An Nd:YAG laser capsulotomy was performed. After this procedure, the eye developed a severe, diffuse inflammation diagnosed as probably endophthalmitis. The intraocular lens and the lens capsular sac were removed. Note the portion of the lens capsule (arrows) and the fibrous metaplasia (F) of the residual lens cortex. The lightly stained material is residual necrotic lens substance. The deeply stained basophilic material (B) at the left is gram positive and represents necrotic organisms. (Gram stain; original magnification, ×30. Courtesy of Francis W. Price, Jr., Indianapolis, Ind. Reprinted with permission [ ].)

Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
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Figure 3

Isolation of bacterial pathogens related to onset of initial symptoms of endophthalmitis following intraocular lens implantation. (Reprinted with permission [ ].)

10.1128/9781555818067/fig14-3_thmb.gif
10.1128/9781555818067/fig14-3.gif
Image of Figure 3
Figure 3

Isolation of bacterial pathogens related to onset of initial symptoms of endophthalmitis following intraocular lens implantation. (Reprinted with permission [ ].)

Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
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Figure 4

Classification of confirmed growth isolates from 291 patients with confirmed growth in the Endophthalmitis Vitrectomy Study. Reprinted from reference with permission from Elsevier Science.

10.1128/9781555818067/fig14-4_thmb.gif
10.1128/9781555818067/fig14-4.gif
Image of Figure 4
Figure 4

Classification of confirmed growth isolates from 291 patients with confirmed growth in the Endophthalmitis Vitrectomy Study. Reprinted from reference with permission from Elsevier Science.

Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
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Tables

Ocular Infections
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Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14
/content/10.1128/9781555818067.chap14.tab14-1
Table 1

Presenting symptoms, signs, and laboratory findings in the Endophthalmitis Vitrectomy Study

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10.1128/9781555818067/tab14-1.gif
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Table 1

Presenting symptoms, signs, and laboratory findings in the Endophthalmitis Vitrectomy Study

Citation: Barequet I, Sullivan Baker A, Schein O. 2000. Ocular Infections, p 287-306. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch14

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