Ndonga T.AMsc TID I

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.  

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.  

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.  

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. 

The eyeball is protected anteriorly by the eyelids

And contained in the orbit

Predorminant organisms Diphtheroids S.epidermidis Non hemolytic strep

The infections could be:- Acute Chronic Primary secondary

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

The normal transparency may be lost Papillae may form especially in tarsal

conjunctiva Symptoms include gritty

eyes,photophobia,diminished vision and pain

*Strep pneumo . C.diphtheria Strep pyogenes .M.tuberculosis strep viridians .francisela *Staph aureus . T.pallidum *H .influenza .moraxella *N.gonorrhoea/meningitidis H.ducreyi . shigella

flexeneri Proteus vulgaris .Y.enterocolitica

Staph epidermidis Acinetobacter Aeromonas hydrophila Peptostreptococcus Bartonella * most common

conjunctivitis

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

Age-neisseriae /chlamydia-newborns Children-influenza,strep pneumo,staph

aureus Young adults-strep pneumo,staph

aureus/epidermidis

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.

Inflammation of the cornea Clinically presents as loss of

vision,,tearing,photophobia and blepharospasm,ulceration

Symptoms-foreign body sensation,pain

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

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

Direct penetration-organisms producing toxins/enzymes/virulent factors-neisseria

Following injury,eyelid abnormalities,tear dysfuntional states,corneal anesthesia

Immunocompromised states Use of contact lenses

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??

Most cases develop after intraocular surgery-cataract surgery.

Organisms involved-microflora Clinically-decreased visual

acuity,pain,hypopion,hyperemia

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

Is according to culture and sensitivity Iv antibiotics-3G cephalosporins Intravitreal vancomycin-s.aureus Sx-vitrectomy Steroids??

These involve orbit and cellular adnexa Principal periocular structure susceptible

to infections are eyelids ,the components of lacrimal apparatus and the orbit.

Inflammation of the lid margins-blepharitis

Often chronic and bilateral Two types-anterior-staphylococcal -posterior-meibominitisOrganisms Staphaureus,epidermidis,pseudomonas,prot

eus,moraxella.Mascara used has been implicated

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

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

Dacroadenitis-inflammation of main lacrimal gland-staph,strep,tuberculosis-chronic

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,

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

Staph aureus Strep pyogenes Strep pneumo Clostridia H.influenza-<5s Tb-hematogenous spread

Evidence of trauma-bleedng,fever,lid edema and rhinorrhoea.

Pain,headache,loss of vision Tenderness,black eye,proptosis

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

Dacroadenitis-systemic antibiotics Cellulitis-cloxacillin,oxacillin,cephalexin Clindamycin for gram neg Iv antibiotics orbital cellulitis

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

Gram stain ELISA Dna/pcr-chlamydia Fluorescent microscopy u/s,ct,MRI for cellulitis

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