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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