Ocular Infections

Irina S. Barequet; Ann Sullivan Baker; Oliver D. Schein

doi:10.1128/9781555818067.ch14

Chapter 14 : Ocular Infections

Authors: Irina S. Barequet¹, Ann Sullivan Baker^3,†, 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

Book DOI: 10.1128/9781555818067

Chapter DOI: 10.1128/9781555818067.ch14

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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 Candida endophthalmitis. 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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Bacterial Keratitis: 0.5554768
Ocular Infections: 0.50449187
Magnetic Resonance Imaging: 0.43450728
Scanning Electron Microscope: 0.42646083

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Ocular Infections

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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.

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Figure 1

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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 [ 4 ].)

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Figure 2

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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 [ 102 ].)

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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 [ 102 ].)

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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 36 with permission from Elsevier Science.

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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 36 with permission from Elsevier Science.

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Tables

Ocular Infections

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Table 1

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

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10.1128/9781555818067/tab14-1.gif

Table 1

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