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26 Cards in this Set
- Front
- Back
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An intraocular infection after recent intraocular surgery (within 6 wks)
Common causes: - CAT & PKP - Vitrectomy - Filtering blebs |
Acute Postoperative Endophthalmitis
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What are some SYMPTOMS of Acute Postoperative Endophthalmitis?
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Patients present with abrupt onset of:
1) Floaters 2) Decreased vision 3) Increased eye pain |
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What are some SIGNS of Acute Postoperative Endophthalmitis?
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1. Hypopyon
2. Vitritis Additional AC signs: 1. Conjunctival injection & chemosis 2. Possibly stromal infiltrate or ulceration at wound site 3. Possibly scleral thinning at wound site |
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What are some methods of diagnosing Acute Postoperative Endophthalmitis?
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1) Ultrasonography
- demonstrates Vitritis - often shows scleral-choroidal thickening Definitive Dx requires: - Culture positive vitreous sample (also used to obtain sensitivities) |
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What's the treatment for Acute Postoperative Endophthalmitis?
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Treatment based on vision at presentation.
Endophthalmitis Vitrectomy Study - HM or better --> intravitreal antibiotics - LP --> pars plana vitrectomy followed by intravitreal antibiotics |
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What's the prognosis for Acute Postoperative Endophthalmitis?
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Depends on causative organism:
1) S. epidermidis - must attain better than 20/40 with tx. 2) S. aureus, Streptococcus, & Gram negative => poor prognosis |
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After years of surgery, a patient c/o:
- Gradual onset of variable decreased vision with photophobia (may be painless) Signs: - Vitritis (with/without hypopyon) - Keratic precipitates - White plaque on IOL or posterior lens capsule |
Late-Onset Endophthalmitis
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May occur anytime after glaucoma filtering surgery.
What's the Dx and Tx? |
a) Bleb-Associated Endophthalmitis'
b) Tx: 1. Topical/oral antibiotics initially 2. Intravitreal antibiotics if does NOT respond quickly |
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Intraocular inflammation after penetrating trauma
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Traumatic Endophthalmitis
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A patient c/o:
- Decreased vision and pain due to penetrating foreign body trauma to eye Signs: - Hypopyon with increased Vitritis What's the Dx & Tx? |
a) Traumatic Endophthalmitis
b) Treatment based on vision at presentation. Endophthalmitis Vitrectomy Study - HM or better --> intravitreal antibiotics - LP --> pars plana vitrectomy followed by intravitreal antibiotics NOTE: Dx & Tx similar to postoperative cases with variable prognosis. |
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What's OD management of Endophthalmitis?
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1. Be on the lookout for intraocular inflammation anytime there is a "HOLE" into the eye.
2. If detected => URGENT referral for vitreal tap |
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Organisms spread to the eye from another source within the body via the bloodstream.
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Endogenous Endophthalmitis
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Septic, immunocompromised, or IV drug user, and those with indwelling catheters c/o:
- Pain - Progressively blurry vision - Floaters - Photophobia - HA - Fever Signs: 1. Chemotic swollen lids & corneal edema 2. Anterior uveitis (sometimes w/hypopyon) 3. Retinal infiltrates 4. Vitreous haze/abscess 5. Retinal necrosis in severe cases What's the Dx & Tx? |
a) Endogenous Endophthalmitis
b) Tx: Suspected cases require referral: 1) to confirm diagnosis & determine systemic cause - ocular cultures (aqueous & vitreous samples) - cultures of blood, urine, catheter tips, CSF, etc 2) For treatment of both ocular & systemic infections |
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Systemic infection by Treponema Pallidum usually contracted sexually or transplacentally.
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Syphilis
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Patient c/o:
- rash - fever - HA - joint pain - nausea - history of chancre at site of inoculation What's the Dx & Tx? |
a) Ocular Syphilis
b) Tx: - Suspicious ocular presentations need to be referred for appropriate blood/CSF tests. 1) IV/IM Pencillin for 10-14 days 2) Secondary Syphilis responds well to Tx |
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A rare manifestation of systemic infection by Mycobacterium tuberculosis or M. bovis.
- Chronic GRANULOMATOUS infection may affect: 1. anterior segment 2. posterior segment 3. ocular adnexae 4. orbit - Spread via inhalation of airborne organisms from patients with pulmonary infection. - Intraocular disease evolves from hematogenous spread |
Ocular Tuberculosis
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What are some common ocular manifestations found in Ocular TB?
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1. Anterior Uveitis (granulomatous)
2. Choroiditis (choroidal granulomas) 3. Periphlebitis (hypersensitivity rxn to bacillus) |
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Ocular TB - often occurs in patients without systemic manifestations of TB. (True/False)
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True
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What are some diagnostic methods for Ocular TB?
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Diagnosis:
- only definitive if organisms cultured from sample taken from patient (sputum, etc) - often presumptive, based on: 1. positive skin test 2. presence of active systemic disease 3. absence of findings for other causes of ocular manifestations |
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What is the treatment for Ocular TB?
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Tx:
1. Requires multiple ANTIBIOTIC meds 2. Steroids controversial, but often used 3. Continues over many months Optometric management: - Identify & initiate proper systemic investigations |
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An infection caused by Borrelia burgdorferi, which is transmitted by the bite of a tick.
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Lyme Disease
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What are some SIGNS found in Lyme Disease?
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- May cause a range of systemic & ocular manifestations including:
1. Choroiditis 2. Neuroretinitis 3. Periphlebitis - Characteristic skin rash at site of bite |
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What is the diagnostic test and treatment for Lyme Disease?
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a) Dx
- utilizes blood tests for antibodies b) Tx: 1. Oral/IV antibiotics - prophylaxis should be given within 72 hrs of a bite |
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What type of questions would you ask a patient with ocular inflammation of UNKNOWN cause?
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1. Tick bite
2. Focal rash 3. Recent hiking, camping, or hunting activities |
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If your case history raises suspicion, then what would you do next?
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Arrange appropriate blood tests
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Neuroretinitis can cause which disease(s)?
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Cat Scratch Disease
Lyme Disease Diffuse Unilateral Subacute Neuroretinitis (DUSN) |
