The Red Eye: Basic Algorithm on How to Differentiate Main Conditions from Each Other
Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen in Practical Emergency Ophthalmology Handbook, 2019
Investigations are useful for diagnosing and differentiating causes of infections: Swabs – Viral, bacterial and Chlamydial can all be taken for signs of conjunctivitis or cellulitis when the cause is not evident from the history or the clinical findings.Corneal scrape of a corneal ulcer helps to identify organisms and direct treatment for speedy resolution. Do not commence topical antibiotic treatment until a scrape has been undertaken!Where available, arrange confocal microscopy to identify acanthamoeba cystsAnterior chamber and vitreous tap/biopsy would be analysed to identify organisms causing infectious uveitis or endophthalmitis.
Selected Human Pathogenic Fungi
Rajendra Prasad, Mahmoud A. Ghannoum in Lipids of Pathogenic Fungi, 2017
Infection with Fusarium ranges from mild skin infection to fulminant disseminated infection. F. oxysporum is the second most common cause of onychomycosis, but deep skin infections are rare. Ocular infections, such as corneal ulcer or endophthalmitis, may occur as a result of trauma or surgery. Other focal infections, such as osteomyelitis, may follow trauma.24 Isolated sinus disease has also been reported. In the neutropenic host, Fusarium can cause rapidly disseminated disease, with mortality reaching 70%. These patients present with refractory fever on broad spectrum antibiotics and even fungal prophylaxis. Approximately 80% develop skin lesions, which may be erythematous macules, palpable or non-palpable purpura, or flaccid pustules.23 The lesions eventually necrose, developing central eschars. Many sites of involvement may be evident, including sinuses, brain, lung, abdominal organs and musculoskeletal system. The infection becomes fatal if it remains undiagnosed. The recovery of bone marrow function is thought to be a critical factor in the recovery of patients diagnosed in time. There are also reports of patients with fungemia, but no signs of tissue invasion or organ involvement. All these patients had indwelling catheters and relatively short episodes of neutropenia, and they responded well to catheter removal and antifungal therapy.24
The cornea
Mary E. Shaw, Agnes Lee in Ophthalmic Nursing, 2018
Corneal ulcers develop as a result of local necrosis of corneal tissue by bacteria, viruses, fungi or Acanthamoeba. The most common corneal ulcer is caused by bacteria such as staphylococcus, pseudomonas or streptococcus. Bacterial invasion and infection can be as a result of corneal trauma, corneal foreign body, chronic blepharitis and contact lens wearing. Lid abnormalities such as entropion, trichiasis and corneal exposure due to incomplete eyelid closure – such as Bell’s palsy – may also lead to the development of corneal ulcer.
Rates of Herpes Simplex Virus Types 1 and 2 in Ocular and Peri-ocular Specimens
Published in Ocular Immunology and Inflammation, 2023
Jay J. Meyer
A 34-year-old male with a history of ankylosing spondylitis, keratoconus and hard contact lens wear, presented with a two day history of redness and soreness of the right eye. Examination revealed a central corneal ulcer without an infiltrate. A corneal swab was sent for culture and HSV-2 was isolated. The patient was diagnosed with herpetic keratitis and treated over the following month with topical acyclovir ointment, topical methylprednisolone, topical fucithalmic, and oral doxycycline which successfully healed the epithelium. A month following closure of the epithelium, corneal ulceration recurred and an infiltrate was visible. Confocal microscopy confirmed the appearance of cysts consistent with acanthamoeba keratitis. Treatment with polyhexamethylene biguanide (PHMB) and brolene resulted in closure of the epithelium and a vascularized corneal scar over the subsequent 2 months and medications were continued for a further 6 months. Over the subsequent 12 years, one episode of stromal keratitis recurred at 8 years following the initial episode and resolved with topical fluorometholone treatment combined with oral acyclovir.
Corneal melting in a case undergoing treatment with pembrolizumab
Published in Clinical and Experimental Optometry, 2020
Chang‐chi Weng, Chih‐chiau Wu, Pei‐yu Lin
On presentation, her best‐corrected visual acuity was 6/15 in the right eye and 6/12 in the left eye. A corneal ulcer with deep stromal melting was noticed in the right eye (Figure 1) and another shallower ulcer in the left eye. Fluorescein staining showed epithelial defects at the ulcer centre with partial healing of epithelium at the ulcer border. There were marked diffuse whole layer stromal cell infiltrates, but no anterior chamber reaction in both eyes. Anterior segment optical coherence tomography revealed the depth of the ulcer (Figure 2). Meanwhile, she also had fever, skin morbilliform rash, pneumonitis, and progressive lower limb weakness and was accordingly admitted to the oncology ward. The skin rash and pneumonitis are common systemic adverse events of pembrolizumab. The accompanying fever is most likely related to the pneumonitis, but the possibility of infection could not be excluded. So, broad‐spectrum antibiotics were used. The progressive lower limb weakness was more likely related to spinal metastasis as revealed by magnetic resonance imaging. The second course of pembrolizumab was held in light of these adverse events.
Infectious Keratitis Caused by Rare and Emerging Micro-Organisms
Published in Current Eye Research, 2020
Pranita Sahay, Siddhi Goel, Ritu Nagpal, Prafulla K. Maharana, Rajesh Sinha, Tushar Agarwal, Namrata Sharma, Jeewan S. Titiyal
Nocardia can cause keratitis, scleritis, and endophthalmitis.9 The clinical course is often prolonged with poor outcome due to delay in diagnosis, and resistance of these micro-organisms to fluoroquinolones.10 The predisposing factors include trauma, contact lens use, topical steroid use and ocular surgery.9 The patient presents with usual symptoms of corneal ulcer. A corneal ulcer with margin studded with yellow-white pinhead-sized superficial infiltrate, and patchy anterior stromal infiltrate arranged in a ring-shaped pattern giving a “wreath-like appearance” in the mid-peripheral cornea is characteristic of this condition.10 Non-specific punctate corneal epitheliopathy has also been observed in a few cases.11
Related Knowledge Centers
- Contact Lens
- Cornea
- Corneal Dystrophy
- Epithelium
- Vitamin A Deficiency
- Corneal Abrasion
- Stroma of Cornea
- Ophthalmology
- Entropion
- Distichia