1. ACINETOBACTER (MIMA POLYMORPHA; ACINETOBACTER IWOFFI)
General
Gram-negative pleomorphic bacillus Mima; generally occurs in patient with lowered resistance.
Ocular
Conjunctivitis and chemosis; corneal ulcer; blepharitis; iris prolapse; endophthalmitis.
Clinical
Meningitis; pneumonitis; endocarditis; urethritis; vaginitis; arthritis; dermatitis; intracranial abscess; subdural empyema.
Laboratory
Culture of the appropriate body fluid that is properly transported, plated, and incubated grows Acinetobacter baumannii.
Treatment
An infectious disease specialist should be consulted to differentiate colonization from infection and for antibiotic recommendations.
BIBLIOGRAPHY
- Cunha BA. (2011). Acinetobacter. [online] Available from www.emedicine.com/med/TOPIC3456.HTM. [Accessed July, 2013].
2. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS; ACQUIRED CELLULAR IMMUNODEFICIENCY; ACQUIRED IMMUNODEFICIENCY)
General
Acquired breakdown of the immune system followed by disease that takes advantage of the body’s collapsed defenses; acquired by shared drug needles or sexual intercourse; occurs most frequently in homosexually active men (75%), intravenous drug abusers (13%), and Haitian immigrants (6%).
Ocular
Retinal cotton-wool spots; cytomegalovirus (CMV) retinitis; retinal periphlebitis; conjunctival Kaposi sarcoma; necrotizing retinitis; retinal hemorrhages; conjunctivitis sicca; orbital Burkitt lymphoma; peripheral retinochoroiditis; vitreitis; fungal corneal ulcer; hypopyon; acute glaucoma; third nerve palsy; anterior uveitis; atypical 2 retinitis; orbital pseudotumor; herpes zoster ophthalmicus; herpes simplex keratitis; bacterial keratitis; molluscum contagiosum; toxoplasma retinitis; acute retinal necrosis; HIV retinitis; syphilitic retinitis; Pneumocystis carinii choroiditis; fungal and bacterial endophthalmitis; fungal choroiditis; conjunctival microvasculopathy; keratitis sicca; subconjunctival hemorrhage.
Clinical
Because of lowered immunity, one third develops Kaposi sarcoma; pneumonia caused by P. carinii; death.
Laboratory
Enzyme-linked immunosorbent assay (ELISA) test is used. For screening, other tests are used to evaluate false-positive and false-negative test results.
Treatment
Medical consultations are required for systemic treatment. The treatment of CMV retinitis can include drugs such as ganciclovir, valganciclovir, fomivirsen, foscarnet and cidofovir. All of these drugs have specific adverse effects and complicate the decision to use for treatment.
BIBLIOGRAPHY
- Copeland RA. (2011). Ocular Manifestations of HIV Infection. [online] Available from www.emedicine.com/oph/TOPIC417.HTM. [Accessed July, 2013].
- Dubin J. (2011). Rapid Testing for HIV. [online] Available from www.emedicine.com/emerg/TOPIC253.HTM. [Accessed July, 2013].
3. ACUTE HEMORRHAGIC CONJUNCTIVITIS (AHC; EPIDEMIC HEMORRHAGIC KERATOCONJUNCTIVITIS, APOLLO 11 DISEASE)
General
First reported in 1969, first epidemic in United States in 1981; enterovirus; explosive onset; usually bilateral; coxsackie virus A24 and enterovirus 70 have been implicated in the most recent outbreaks.
Ocular
Chemosis; follicular conjunctivitis; petechial bulbar hemorrhages; seromucous discharge; keratitis; lacrimation; lid edema; photophobia; preauricular lymphadenopathy.
Clinical
Systemic symptoms are rare, although several cases of lumbosacral radiculomyelitis have occurred late in the course of the disease; polio-like paralysis (associated with enterovirus 70).
Laboratory
Antisera have been used with good results. These are being supplanted by polymerase chain reaction (PCR) methods, which reduce the time needed for viral typing.
Treatment
Very contagious with transmitted eye to hand to eye contact. Self-limited course; generally no treatment is necessary.
BIBLIOGRAPHY
- Plechaty G. (2011). Acute Hemorrhagic Conjunctivitis. [online] Available from www.emedicine.com/oph/TOPIC492.HTM. [Accessed July, 2013].
4. ASPERGILLOSIS
General
Systemic infection common in poultry farmers, feeders or breeders of pigeons, and persons who work with grains; should be considered in immunocompromised patients.
Ocular
Corneal ulcer; blepharitis; keratitis; scleritis; endophthalmitis; exophthalmos; retinal hemorrhages; retinal detachment; vitreitis; cataract; conjunctivitis; orbital cellulitis; paresis of extraocular muscles; secondary glaucoma; scleromalacia perforans; endogenous endophthalmitis; anterior chamber mass; invasion of choroid and anterior optic nerve.
Clinical
Pulmonary infections; invasive fungal disease.
Laboratory
Culture from superficial scrapings from bed of infection.
Treatment
Voriconazole is the drug of choice. Although disease outcomes substantially improve with antifungal treatment, patient survival and infection resolution depend on improved immunosuppression.
BIBLIOGRAPHY
- Batra V. (2011). Pediatric Aspergillosis. [online] Available from www.emedicine.com/ped/TOPIC148.HTM. [Accessed July, 2013].
5. BACILLUS SPECIES INFECTIONS
General
Aerobic, Gram-positive spore-forming rods which are the cause of many ocular infections; most common cause of post-traumatic endophthalmitis in rural settings. Most commonly enters the eye as a result of penetrating trauma with a contaminated foreign body but can be related to intravenous drug use. Extremely poor visual outcome is associated with this infection.
Clinical
Fever, leukocytosis.
Ocular
Corneal ring infiltrate, diffuse subepithelial infiltrates, hypopyon, vitritis.
Laboratory
Gram stain reveals a Gram-positive rod.
Treatment
Antibiotic (generally vancomycin) should be given intravitreal, topical and systemic. Due to the aggressive nature of Bacillus cereus, a vitreous tap with antibiotic injection alone is not recommended. Pars plana vitrectomy with intravitreal injection of vancomycin is the treatment of choice.
BIBLIOGRAPHY
- Egan DJ. (2011). Endophthalmitis. [online] Available from www.emedicine.com/emerg/TOPIC880.HTM. [Accessed July, 2013].
6. BLASTOMYCOSIS
General
Chronic fungal disease caused by Blastomyces dermatitidis.
Ocular
Hypopyon; mycotic keratitis; corneal ulcer; choroidal granuloma; nodules of iris; cicatrization of eyelid; ectropion; descemetocele; panophthalmitis; recurrent papillomatous lesion upper lid; granulomatous conjunctivitis.
Clinical
Granulomatous lesions of skin, lung, bone, or any part of the body.
Laboratory
Periodic acid-Schiff and Gomori methenamine-silver stains.
Treatment
Therapeutic approaches involve the use of oral azoles, primarily itraconazole. Ocular treatment may include surgical draining of the lid in addition to antifungal therapy.
BIBLIOGRAPHY
- Steele RW. (2011). Pediatric blastomycosis. [online] Available from www.emedicine.com/ped/TOPIC254.HTM. [Accessed July, 2013].
7. BRUCELLOSIS (BANG DISEASE; MALTA FEVER; MEDITERRANEAN FEVER; PIG BREEDER DISEASE; GIBRALTAR FEVER; UNDULANT FEVER)
General
Transmitted to man from animals or animal products containing bacteria of the genus Brucella; human infection results from ingestion of infected animal tissue and milk products or through skin wounds directly bathed in freshly killed animal tissues.
Ocular
Conjunctivitis; punctate keratitis; optic neuritis; swollen optic nerves; chorioretinitis; extraocular muscle palsies; phlyctenules; dacryoadenitis; papilledema; episcleritis; macular edema; phthisis bulbi; uveitis; vitreous opacities; changes in intraocular pressure (early decrease or late increase).
Clinical
Fever; icterus; weakness; sweats; general malaise; mammary abscess.
Laboratory
Increasing serum agglutination test.
Treatment
The goal of medical therapy is to prevent complications and relapses. Multidrug antimicrobial regimens are the mainstay of therapy. Ocular treatment includes topical steroids and cycloplegics for uveitis.
BIBLIOGRAPHY
- Al-Nassir W. (2011). Brucellosis. [online] Available from www.emedicine.com/med/TOPIC248.HTM. [Accessed July, 2013].
8. CANDIDIASIS
General
Yeast-like opportunistic fungal infection caused by Candida albicans.
Ocular
Uveitis; hypopyon; conjunctivitis; keratitis; corneal ulcer; blepharitis; endophthalmitis; dacryocystitis; papillitis; retinal atrophy; Roth spot; vitreous abscess; retrobulbar abscess; retinal detachment; panophthalmitis; chorioretinitis; infectious crystalline keratopathy.
Clinical
C. albicans normally is present as an intestinal saprophyte in 35–75% of the human population; in situations of internal environmental change, however, Candida can become pathogenic (e.g. obesity, diabetes mellitus, malignancy, and other debilitating conditions).
Laboratory
Common yeast from up to 50% of healthy individuals iso-late directly from the eye should be attempted to confirm the presence of organism. Blood agar and Sabouraud’s dextrose agar may be used; PCR for species identification.
Treatment
Mucocutaneous infection typically responds to topical therapy. Antifungal therapy should be started immediately after necessary cultures have been obtained from all suspected sites of infection. Infectious disease specialists are typically involved in cases of invasive candidiasis.
BIBLIOGRAPHY
- Hedayati T. (2012). Candidiasis in Emergency Medicine. [online] Available from www.emedicine.com/emerg/TOPIC76.HTM. [Accessed July, 2013].
9. CATSCRATCH OCULOGLANDULAR SYNDROME (PARINAUD CONJUNCTIVA-ADENITIS SYNDROME; PARINAUD OCULOGLANDULAR SYNDROME; CATSCRATCH DISEASE; BARTONELLA HENSELAE)
General
Most frequently seen in children; incubation time 7-10 days; caused by small pleomorphic Gram-negative bacillus; good prognosis; affects both sexes; about 90% of patients with this condition have serologic evidence of infection by Rochalimaea henselae.
Ocular
Conjunctivitis; retrotarsal conjunctival granulations; formation of granulomata in anterior segment about 3 mm high and 2-6 mm in diameter; inferior fornix usually affected; ulceration common; neuroretinitis; optic neuritis.
Clinical
Tender, red papule at the site of a cat scratch; regional preauricular and cervical lymphadenitis (often only one gland involved); irregular fever for 4-5 days and malaise; fever; parotid gland swelling.
Laboratory
Histopathology of biopsied lymph node of Warthin-Starry silver stain.
Treatment
Symptomatic treatment includes warm compresses, analgesics and antipyretics. Aspiration of lymph node if distention causes pain. Antibiotics may be necessary in severe cases.
BIBLIOGRAPHY
- Nervi SJ. (2011). Catscratch Disease. [online]. Available from www.emedicine.com/med/TOPIC304.HTM. [Accessed July, 2013].
- Chi SL, Stinnett S, Eggenberger E, et al. Clinical characteristics in 53 patients with cat scratch optic neuropathy. Ophthalmology.2012;119:183–7.
10. COCCIDIOIDOMYCOSIS (VALLEY FEVER, SAN JOAQUIN FEVER)
General
Caused by fungus Coccidioides immitis.
Ocular
Conjunctivitis; choroiditis; uveitis; retinal hemorrhages; vitreal opacity; vitreal floaters; episcleritis; hypopyon; granulomatous lesion of optic nerve head; paralysis of sixth cranial nerve; secondary glaucoma; papilledema; mutton fat keratitic precipitates; necrotizing granulomatous conjunctivitis; iridocyclitis.
Clinical
Mild respiratory illness; cavity lung lesion.
Laboratory
Routine culture media, IgM antibody of acute, IgG antibody for present or past infection.
Treatment
Systemic fluconazole or amphotericin B is the treatment of choice. Ocular treatment includes topical amphotericin B and use of steroids sparingly.
BIBLIOGRAPHY
- Hospenthal DR. Coccidioidomycosis. [online] Available from www.emedicine.com/ped/TOPIC423.HTM. [Accessed July, 2013].
11. DEERFLY FEVER (FRANCIS DISEASE; RABBIT FEVER; TULAREMIA; DEERFLY TULAREMIA)
General
Acute infectious disease caused by Francisella (Pasteurella) tularensis.
Ocular
Chemosis; conjunctivitis; corneal ulcer; endophthalmitis; dacryocystitis; optic atrophy; iris prolapse; chalazion; corneal opacity; pannus.
Clinical
Local ulcerative lesion; suppuration of regional lymph nodes; fever; prostration; myalgia; severe headache; pneumonia.
Laboratory
Diagnosis is usually based on serology results. Tularemia tube agglutination testing is the most commonly used serological test.
Treatment
Systemic antibiotics
BIBLIOGRAPHY
- Cleveland KO, Gelfand M, Raugi GJ. (2013). Tularemia. [online]. Available from www.emedicine.com/med/TOPIC2326.HTM. [Accessed July, 2013].
12. DENGUE FEVER
General
Endemic over the tropics and subtropics; caused by four distinct serogroups of dengue viruses: types 1, 2, 3 and 4, group B arboviruses; transmitted solely by mosquitoes of the genus Aedes.
Ocular
Lid edema; conjunctivitis; ocular and retrobulbar pain accentuated by ocular movement; dacryoadenitis; keratitis; corneal ulcer; iritis; retinal or vitreous hemorrhages; ocular motor paresis; optic atrophy.
Clinical
Hemorrhagic fever, severe headache; backache; joint pain; rigors; insomnia; anorexia; loss of taste; epistaxis; rashes; maculopapular rash; myalgia; human infection with of four serotypes of dengue virus causing two diseases: classic dengue fever and dengue hemorrhagic fever (50% mortality).
Laboratory
Basic metabolic panel, liver function test, coagulation studies, chest X-ray, serial ultrasonography.
Treatment
A self-limited illness, and only supportive care is required. Acetaminophen may be used to treat patients with symptomatic fever. Dengue hemorrhagic fever warrant closer observation. Rehydration with intravenous fluids, plasma expander, transfusion and shock therapy may be necessary.
BIBLIOGRAPHY
- Shepherd SM, Hinfey PB, Shoff WH. (2013). Dengue. [online] Available from www.emedicine.com/med/TOPIC528.HTM. [Accessed July, 2013].
13. DERMATOPHYTOSIS (EPIDERMOPHYTOSIS; EPIDERMOMYCOSIS; RUBROPHYTIA; TINEA; TRICHOPHYTOSIS)
General
Superficial infection of the skin; ringworm fungi; most frequently seen in children during hot, humid weather.
Ocular
Conjunctivitis; corneal ulcer; madarosis; scaly rash; folliculitis; blepharitis; lid edema.
Clinical
Scalp, facial, and lid ringworm lesions.
Laboratory
Rapid identification on PCR. Septate hyphae branches on 20% potassium hydroxide stain.
Treatment
Topical treatment involves antifungal cream. Systemic treatment involves use of ketoconazole for 2-4 weeks.
BIBLIOGRAPHY
- Kao GF. (2011). Tinea Capitis. [online] Available from www.emedicine.com/derm/TOPIC420.HTM. [Accessed July, 2013].
14. DIPHTHERIA
General
Acute infectious disease caused by Corynebacterium diphtheriae; severity is dependent upon the amount of exotoxin absorbed prior to initiation of specific therapy.
Ocular
Conjunctivitis; xerophthalmia; keratitis; corneal ulcer; blepharitis; cellulitis of lid; meibomianitis; ptosis; dacryocystitis; cataract; central retinal artery occlusion; optic neuritis; accommodative spasm or paralysis; convergence paralysis; divergence paralysis; paralysis of third, fourth, or sixth nerve; paralysis of accommodation (in children); ocular motor nerve paresis; choroiditis; cranial neuropathies involving the trigeminal, vagus, and hypoglossal cranial nerves; myocarditis.
Clinical
Local inflammatory lesion, with effect on heart, kidneys, and nervous system.
Laboratory
Gram-positive rods commonly affect children younger than 10 years.
Treatment
Systemic treatment involves use of diphtheria antitoxin and antibiotics. Ocular treatment includes diphtheria antitoxin and high titer y-globulin preparation. Topical penicillin-G ointment helps to eradicate the bacilli.
BIBLIOGRAPHY
- Demirci CS. (2011). Pediatric Diphtheria. [online] Available from www.emedicine.com/ped/TOPIC596.HTM. [Accessed July, 2013].
15. EPIDEMIC KERATOCONJUNCTIVITIS
General
Highly communicable; adenovirus types 8 and 19; usually bilateral; epidemic keratoconjunctivitis has been reported worldwide associated with 11 virus serotypes, with serotypes 8, 11, and 19 being the most common responsible ones.
Ocular
Follicular or membranous conjunctivitis; chemosis; subconjunctival hemorrhages; corneal opacity; punctate epithelial keratitis; corneal ulcer; blepharospasm; lid edema; serous discharge; uveitis; epiphora.
Clinical
Submaxillary and cervical lymphadenopathy.
Laboratory
Viral isolation on cell culture from conjunctival scrapings.
Treatment
No effective topical or systemic treatment available. Topical steroids may be used if epithelial keratitis occurs.
BIBLIOGRAPHY
- Bawazeer A. (2011). Epidemic Keratoconjunctivitis. [online] Available from www.emedicine.com/oph/TOPIC677.HTM. [Accessed July, 2013].
16. ERYSIPELAS (SAINT ANTHONY FIRE)
General
Acute localized inflammation of the skin and subcutaneous tissue; erysipelas is a febrile infection of the skin and subcutaneous tissue, most commonly caused by Streptococcus, characterized by the acute onset of a red, indurated expanding plaque that nearly disappears with the use of antibiotics; sometimes caused by Staphylococcus.
Ocular
Conjunctivitis; blepharitis; elephantiasis and gangrene of lid; ptosis; dacryocystitis; cellulitis of orbit; keratitis; panophthalmitis; uveitis; eyelid involvement.
Clinical
Edema; fever; rigor; vesicles; tenderness; headache; vomiting; localized pain.
Laboratory
Blood cultures, needle aspirates or biopsy yields less than 10% positive cultures; direct immunofluorescence is useful to detect Streptococcus in skin specimens.
Treatment
Systemic treatment is penicillin G. Ocular treatment is to clean and debridement of wound and use of a broad-spectrum antibiotic ointment.
BIBLIOGRAPHY
- Binford RT, Lindo SD. Dermatologic conditions affecting the eye. In: Dunlap EA(Ed). Gordon’s Medical Management of Ocular Disease, 2nd edition. New York: Harper & Row; 1976. pp. 91-110.
- Bratton RL, Nesse RE. St. Anthony’s fire: diagnosis and management of erysipelas. Am Fam Physician.1995;51:401-4.
- Duane TD. Clinical Ophthalmology. Philadelphia: JB Lippincott; 1987.
- Roy FH, Fraunfelder FH, Fraunfelder FT. Roy and Fraunfelders's Current Ocular Therapy, 6th edition. Philadelphia: WB Saunders; 2008.
- McHugh D, Fison PN. Ocular erysipelas. Arch Ophthalmol. 1992;110:1315.
17. ESCHERICHIA COLI
General
Gram-negative rod found in the gastrointestinal tract; urinary tract is the usual portal of entry.
Ocular
Uveitis; hyphema; hypopyon; gas bubbles in anterior chamber; purulent conjunctivitis; keratitis; corneal edema; panophthalmitis; endophthalmitis; glaucoma.
Clinical
Diarrhea; gastroenteritis; dehydration.
Laboratory
Anaerobic Gram-negative rod.
Treatment
Antibiotic therapy should start with ampicillin until sensitivity reports return.
BIBLIOGRAPHY
- Suh DW. (2011). Ophthalmologic Manifestations of Escherichia Coli. [online] Available from www.emedicine.com/oph/TOPIC496.HTM. [Accessed July, 2013].
18. GONORRHEA
General
Caused by Neisseria gonorrhoeae, which is transmitted sexually.
Ocular
Conjunctivitis; eyelid edema; keratitis; uveitis.
Clinical
Pelvic inflammatory disease; arthritis; dermatitis; carditis; meningitis.
Laboratory
Gram stain smear demonstrates Gram-negative diplococci with polymorphonuclear leukocytes in conjunctival exudates.
Treatment
Therapy consists of systemic antibiotics; topical antibiotics are relatively ineffective in the treatment of eye disease. It is important to treat all sexual partners simultaneously to prevent reinfection.
BIBLIOGRAPHY
- Wong B. (2012). Gonorrhea. [online] Available from www.emedicine.com/oph/TOPIC497.HTM. [Accessed July, 2013].
19. HAEMOPHILUS AEGYPTIUS (KOCH-WEEKS BACILLUS)
General
Caused by Gram-negative Koch-Weeks bacillus in warm climate regions; characterized by a 24- to 48-hour incubation period; now classified as Haemophilus influenzae biotype III; H. influenzae is divided into biotypes based on biochemical reactions (indole production, urease activity, ornithine decarboxylase activity) and into serotypes based on their capsular polysaccharides; common cause of purulent conjunctivitis and preseptal cellulitis in children.
Ocular
Conjunctivitis; corneal opacity; corneal ulcer; phlyctenular keratoconjunctivitis; keratitis; cellulitis of lid; pseudoptosis; uveitis; petechial subconjunctival hemorrhages.
Clinical
Coryza; systemic symptoms are rare.
Laboratory
Poorly staining Gram-negative bacilli or coccobacilli. Culture on chocolate agar.
Treatment
Antibiotics are the mainstay of treatment. Invasive and serious infections are best treated with an intravenous third-generation cephalosporin until antibiotic sensitivities are available.
BIBLIOGRAPHY
- Devarajan VR. (2012) Haemophilus Influenzae Infections. [online]. Available from. www.emedicine.com/med/TOPIC936.HTM. [Accessed July, 2013].
20. HAEMOPHILUS INFLUENZAE
General
Gram-negative rod.
Ocular
Conjunctivitis; cellulitis; tenonitis; uveitis; vitreous opacity; pannus; corneal opacity.
Clinical
Pharyngitis; epiglottitis; laryngotracheitis; pneumonia; bronchitis; otitis media; meningitis; cellulitis; septic arthritis; sinusitis.
Laboratory
Gram-negative coccobacillus with eight biotypes and six serotypes. Gram stain and culture.
Treatment
Antibiotics are the mainstay of treatment. Invasive and serious infections are best treated with an intravenous third-generation cephalosporin until antibiotic sensitivities are available.
BIBLIOGRAPHY
- Devarajan VR. (2012). Haemophilus Influenzae Infections. [online] Available from www.emedicine.com/med/TOPIC936.HTM. [Accessed July, 2013].
21. HANSEN DISEASE (LEPROSY)
General
Communicable disease caused by Mycobacterium leprae.
Ocular
Keratitis; leukoma; pannus; corneal ulcer; uveitis; iris atrophy; dacryocystitis; anisocoria; multiple pupils; decreased or absent pupillary reaction to light; paralysis of seventh nerve; episcleritis; blepharospasm; lagophthalmos; madarosis; secondary glaucoma; decreased intraocular pressure; subconjunctival fibrosis; punctate epithelial keratopathy; posterior subcapsular cataract; corneal hypesthesia; prominent corneal nerves; iridocyclitis; foveal avascular keratitis; scleritis; interstitial keratitis; iris pearls; dry eye.
Clinical
Disease affects primarily the skin, mucous membrane, and peripheral nerves.
Laboratory
Skin biopsy specimens contain vacuolated macrophages, few lymphocytes, and numerous acid-fast bacilli often in clumps or globi.
Treatment
The World Health Organization (WHO) recommends multiple drug therapy (MDT) for all forms of leprosy. MDT 14 consists of rifampin, ofloxacin, and minocycline.
BIBLIOGRAPHY
- Kim EC. (2011) Ocular Manifestations of Leprosy. [online] Available from www.emedicine.com/oph/TOPIC743.HTM. [Accessed July, 2013].
22. HERPES SIMPLEX
General
Large, complex deoxyribonucleic acid (DNA) virus.
Ocular
Conjunctivitis; keratitis; iridocyclitis; corneal ulcer; uveitis; hyphema; hypopyon; iris atrophy; cataract; scleritis; dacryoadenitis; blepharitis; acute retinal necrosis.
Clinical
Recurrent skin vesicles on lids, perioral area, nose and genitalia; meningitis, encephalitis.
Laboratory
Viral cultures.
Treatment
Antiviral therapy, topical or oral, is an effective treatment of epithelial herpes infection.
BIBLIOGRAPHY
- Shaohui L, Pavan-Langston D, Colby KA. Pediatric herpes simplex of the anterior segment: characteristics, treatment, and outcomes. Ophthalmology.2012;119:2003-8.
- Wang JC. (2010). Ophthalmologic Manifestations of Herpes Simplex Keratitis. [online] Available from www.emedicine.com/oph/TOPIC100.HTM. [Accessed July, 2013].
23. HERPES SIMPLEX MASQUERADE SYNDROME
General
Acanthamoeba keratitis occurs in those who wear soft contact lenses daily; confused with herpes simplex; Acanthamoeba culbertsoni, Acanthamoeba castellanii and Acanthamoeba polyphaga are causative agents; agents found in distilled water, hot tubs, and swimming pools (see Acanthamoeba).
Ocular
Keratitis; corneal ulcer; corneal cysts; stromal infiltrates and necrosis; scleritis; uveitis; epiphora; pseudodendrites.
Clinical
None.
Laboratory
Corneal smears and cultures.
Treatment
Antibiotics are used to treat the ulcer, lubrication, oral tetracycline, proper wear of contact lens.
BIBLIOGRAPHY
- Hoft RH, Mondino BJ. The diagnosis and clinical management of acanthamoeba keratitis. Semin Ophthalmol. 1991;6:106.
- Johns KJ, O’Day DM, Head WS, et al. Herpes simplex masquerade syndrome: acanthamoeba keratitis. Curr Eye Res.1987;6:207-212.
- Moore MB, McCulley JP, Luckenbach M, et al. Acanthamoeba keratitis associated with soft contact lenses. Am J Ophthalmol.1985;100:396-403.
- Samples JR, Binder PS, Luibel FJ, et al. Acanthamoeba keratitis possibly acquired from a hot tub. Arch Ophthalmol.1984;102:707-10.
- Wilhelmus KR. Parasitic keratitis and conjunctivitis. In: Smolin G Thoft RA (Eds). The Cornea, 3rd edition. Boston: Little, Brown and Company; 1994. pp. 262-6.
24. INCLUSION CONJUNCTIVITIS (CHLAMYDIA; PARATRACHOMA)
General
Organism that infects the epithelium of mucoid surfaces; sexually transmitted; major cause of non-gonococcal urethritis in men and cervicitis in women; major cause of neonatal ophthalmia; Chlamydia trachomatis is an intracellular bacterium lacking respiratory enzymes that has an affinity for mucosal epithelium; serotypes A through C have been epidemiologically associated with trachoma; serotypes E through K have been associated with genital infection and keratoconjunctivitis in sexually active adults and neonates; other serotypes have been associated with lymphogranuloma venereum and Reiter syndrome.
Ocular
Follicular conjunctivitis; corneal opacities; keratitis; corneal ulcer; lid edema; uveitis.
Clinical
Pneumonia; gastrointestinal disturbances; genital discharge.
Laboratory
Giemsa stain, cell culture—time intensive, direct fluorescent monoclonal antibiotics to stain smears.
Treatment
Three to six weeks of oral tetracycline (500 mg qid), oral doxycycline (100 mg bid), or oral erythromycin stearate (500 mg qid). Simultaneous treatment of all sexual partners is important to prevent reinfection.
BIBLIOGRAPHY
- Bashour M. (2012). Ophthalmologic Manifestations of Chlamydia. [online] Available from www.emedicine.com/oph/TOPIC494.HTM. [Accessed July, 2013].
25. INFECTIOUS MONONUCLEOSIS (MONONUCLEOSIS; EPSTEIN-BARR VIRUS, ACUTE; ACUTE EPSTEIN-BARR VIRUS, GLANDULAR FEVER)
General
Asymptomatic in childhood; manifested in late adolescence of early adulthood; associated with Burkitt lymphoma and nasopharyngeal carcinoma.
Ocular
Conjunctivitis; ptosis; hippus; dacryocystitis; episcleritis; hemianopsia; nystagmus; retinal and subconjunctival hemorrhages; optic neuritis; orbital edema; scotoma; paralysis of extraocular muscles; uveitis; peripheral choroiditis; keratitis; papilledema; scleritis; retrobulbar neuritis, Sjögren syndrome; retinitis, choroiditis.
Clinical
Fever; widespread lymphadenopathy; pharyngitis; hepatic involvement; presence of atypical lymphocytes and heterophile antibodies in the blood; fatigue.
Treatment
A self-limited illness that does not usually require specific therapy. Splenic rupture is an acute abdominal emergency that usually requires surgical intervention.
BIBLIOGRAPHY
- Cunha BA. (2011). Infectious Mononucleosis. [online]. Available from www.emedicine.com/med/TOPIC1499.HTM. [Accessed July, 2013].
26. INFLUENZA
General
Acute respiratory infection of specific viral etiology which includes H1N1.
Ocular
Conjunctivitis; subconjunctival hemorrhages; keratitis; tenonitis; ptosis; cellulitis of orbit and lid; dacryocystitis; retinal hemorrhage; cataract; episcleritis; hypopyon; optic neuritis; uveitis; panophthalmitis; vitreal hemorrhage; paralysis of third or fourth nerve; uveitis following vaccination for influenza.
Clinical
Headache; fever; malaise; muscular aching; substernal soreness; nasal stuffiness; nausea.
Laboratory
The criterion standard for diagnosing influenza A and B is a viral culture of nasal-pharyngeal samples, throat samples, or both.
Treatment
Prevention is the most effective therapy. Two new drugs have been marketed recently for treatment of influenza A and B. These are the neuraminidase inhibitors, oseltamivir and zanamivir.
BIBLIOGRAPHY
- Derlet RW. (2012). Influenza. [online] Available from www.emedicine.com/med/TOPIC1170.HTM. [Accessed July, 2013].
27. LEPTOSPIROSIS (WEIL DISEASE)
General
Acute severe infection caused by Leptospira transmitted by ingestion of food contaminated by the reservoir bacterium.
Ocular
Acute conjunctivitis; episcleritis; fibrinous iridocyclitis with vitreal haze; hypopyon; keratitis; pain on ocular movement; uveitis; optic neuritis; cataract; hemorrhagic retinitis; ptosis.
Clinical
Jaundice; fever; headaches; chills; vomiting; anemia; psychologic disturbances.
Laboratory
Complete blood count (CBC), urinalysis and isolation of organism in blood, urine or cerebrospinal fluid.
Treatment
Intravenous penicillin G for a week. Ceftriaxone can also be used.
BIBLIOGRAPHY
- Hickey PW. (2012). Pediatric Leptospirosis. [online] Available from www.emedicine.com/ped/TOPIC1298.HTM. [Accessed July, 2013].
28. LYME DISEASE
General
Caused by tick bite; symptoms resolve after treatment.
Ocular
Keratitis may occur up to 5 years after the first episode; diplopia; photophobia; ischemic optic neuropathy; iritis; panophthalmitis; conjunctivitis; exudative retinal detachment; choroiditis; vitreitis; multiple cranial nerve palsies; association with acute, posterior, multifocal, placoid, pigment epitheliopathy; branch retinal artery occlusion.
Clinical
Arthritis; increased intracranial pressure; effusion of knees; swelling of wrists.
Laboratory
Immunofluorescent assay (IFA) and ELISA.
Treatment
Oral antibiotics for 2-3 weeks: tetracycline 500 mg four times a day, doxycycline 100 mg two times a day, phenoxymethyl penicillin 500 mg four times a day, or amoxicillin 500 mg three to four times a day.
BIBLIOGRAPHY
- Zaidman GW. (2011). Ophthalmic Aspects of Lyme Disease Overview of Lyme Disease. [online] Available from www.emedicine.com/oph/TOPIC262.HTM. [Accessed July, 2013].
29. MARSEILLES FEVER (BOUTONNEUSE FEVER)
General
Caused by Rickettsia conorii and transmitted by ticks.
Ocular
Conjunctivitis; central serous retinopathy; retinal detachment; perivasculitis; uveitis; papillitis; keratitis.
Clinical
Fever; lymph node enlargement; papular rash.
Laboratory
Serology is usually a confirmatory method; however, these tests are useful only after an acute infection. Culture of the organism may be used for diagnosis early in the course of the disease.
Treatment
Tetracyclines with chloramphenicol and quinolones may be considered first-line antibiotics. Patients with the benign form are usually treated with antibiotics for 7 days. Patients with the malignant form are usually treated with antibiotics for 2 weeks.
BIBLIOGRAPHY
- Zalewska A, Schwartz RA. (2011). Boutonneuse Fever. [online] Available from www.emedicine.com/derm/TOPIC759.HTM. [Accessed July, 2013].
30. MICROSPORIDIAL INFECTION
General
Obligate intracellular, spore-forming, mitochondrial-lacking eukaryotic protozoan parasites.
Clinical
None.
Ocular
Photophobia, blepharospasm, nonspecific or papillary conjunctival hyperemia.
Laboratory
Gram stain smear show Gram-positive, void spores in the cytoplasm of epithelial cells.
Treatment
Topical fumagillin which can be prepared from fumagillin bicylohexylammonium salt (Fumadil B).
BIBLIOGRAPHY
- Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder's Current Ocular Therapy, 6th edition. London: Elsevier; 2008.
31. MOLLUSCUM CONTAGIOSUM
General
Etiologic agent of this disease is a poxvirus that can cause proliferative skin lesions anywhere on the body; commonly found in patients who are immunosuppressed.
Ocular
Lesions of lid, lid margin, conjunctiva, and cornea; conjunctivitis; keratitis; corneal ulcer.
Clinical
Well-defined, pearly appearing papules with umbilicated centers of varying size (3-10 mm); eczematization of the surrounding skin.
Laboratory
Craters have epithelial cells with large eosinophilic intracytoplasmic inclusion bodies (molluscum or Henderson Patterson bodies) when virus particles migrate to the granular layer of the epidermis, the inclusion bodies become basophilic.
Treatment
Topical agents cantharidin, tretinoin, podophllin, trichloroacetic acid, tincture of iodine, silver nitrate or phenol, potassium hydroxide. Systemic agents include griseofulvin, methisazone and cimetidine.
BIBLIOGRAPHY
- Bhatia AC. (2012). Molluscum Contagiosum. [online] Available from www.emedicine.com/oph/TOPIC500.HTM. [Accessed July, 2013].
32. MORAXELLA LACUNATA
General
Gram-negative rod; causes chronic angular blepharoconjunctivitis; without treatment, may persist for months or years; normally found in flora of respiratory tract; seen more frequently in alcoholics and those with poor sanitary habits; Moraxella organisms produce proteases, although those are not related directly to their pathogenetic mechanism.
Ocular
Catarrhal angular conjunctivitis; corneal ulcer; hypopyon, chronic blepharitis; eczema; lateral canthal skin erythema; iridocyclitis.
Clinical
Alcoholism; impaired nutrition; dermatitis.
Laboratory
Aerobic, oxidase positive, Gram-negative diplococcus or coccobacilli morphologically indistinguishable from Neisseria.
Treatment
Artificial tears, cold compresses, antibiotics.
BIBLIOGRAPHY
- Baum J, Fedukowicz HB, Jordan A. A survey of Moraxella corneal ulcers in a derelict population. Am J Ophthalmol.1980;90:476-80.
- Burd EM. Bacterial keratitis and conjunctivitis. In: Smolin G Thoft RA (Eds). The Cornea. Boston: Little, Brown and Company; 1994. pp. 20-1.
- Roy FH, Fraunfelder FW. Current Ocular Therapy, 6th edition. Philadelphia: WB Saunders; 2008.
- van Bijsterveld OP. The incidence of Moraxella on mucous membranes and the skin. Am J Ophthalmol.1972;74:72-6.
33. MUCORMYCOSIS (PHYCOMYCOSIS)
General
Acute, often fatal infection caused by saprophytic fungi; associated with diabetes mellitus and ketoacidosis.
Ocular
Corneal ulcer; striate keratopathy; ptosis; panophthalmitis; proptosis; cellulitis of orbit; immobile pupil; retinitis; optic neuritis; paralysis of extraocular muscles; central retinal artery thrombosis.
Clinical
Epistaxis; nasal discharge; facial pain; facial palsies; anhidrosis; cranial nerve or peripheral motor and sensory nerve deficits may occur.
Laboratory
Tissue biopsy and culture of paranasal sinuses demonstrate the presence of the fungi, which appear as broad, irregular, nonseptate, branching hyphae on Hematoxylin and Eosin (H & E) stain.
Treatment
Amphotericin B.
BIBLIOGRAPHY
- Crum-Cianflone NF. (2011). Mucormycosis. [online] Available from www.emedicine.com/oph/TOPIC225.HTM. [Accessed July, 2013].
34. MUMPS
General
Viral infection.
Ocular
Conjunctivitis; keratitis; corneal ulcer; tenonitis; exophthalmos; microphthalmos; optic atrophy; optic neuritis; papillitis; scleritis; uveitis; cortical blindness; congenital punctal occlusion; paralysis of extraocular muscles; dacryoadenitis; iritis; paralysis of accommodation; internal and external ophthalmoparesis.
Clinical
Affects the parotid glands, but infection of other glandular tissue occurs, including the lacrimal gland and testicles; encephalitis; meningitis.
Laboratory
Mumps virus by acute serologic studies.
Treatment
Generous hydration and alimentation, analgesics for headaches. No antiviral agent is available.
BIBLIOGRAPHY
- Defendi GL. (2012). Mumps. [online] Available from www.emedicine.com/ped/TOPIC1503.HTM. [Accessed July, 2013].
35. NEWCASTLE DISEASE (FOWLPOX)
General
Acquired directly by people handling chickens (see Parinaud Oculoglandular Syndrome); self-limiting conjunctivitis caused by a paramyxovirus.
Ocular
Acute follicular conjunctivitis, unilateral; keratitic precipitates; lid edema; decreased accommodation and visual acuity.
Clinical
Fatigue; fever; headache; pulmonary complications; preauricular lymphadenopathy.
Laboratory/conjunctivitis
Diagnosis is made by clinical findings.
Treatment
Topical antibiotics, cold compresses, artificial tears.
BIBLIOGRAPHY
- Gordon S. Viral keratitis and conjunctivitis. Adenovirus and other nonherpetic viral diseases. In: Smolin G Thoft RA (Eds). The Cornea. Boston: Little, Brown and Company; 1994.
- Pau H. Differential diagnosis of eye diseases. New York: Thieme; 1987.
- Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder's Current Ocular Therapy, 6th edition. London: Elsevier; 2008.
36. NOCARDIOSIS
General
Aerobic Actinomycetaceae that may cause a chronic suppurative process; aerobic Gram-positive filamentous bacteria with branching pattern which resemble fungi.
Ocular
Conjunctivitis; keratitis; corneal ulcer; uveitis; lid involvement; orbital cellulitis; endophthalmitis; glaucoma; external ophthalmoplegia; scleritis; canaliculitis; preseptal cellulitis.
Clinical
Granuloma; draining sinuses; brain abscess; meningitis.
Laboratory
Gram-positive filamentous structures with an intermittent or a beaded staining pattern, weakly acid-fast. Organism culture from the infection (i.e. respiratory secretion, skin biopsies, or aspirates from abscesses).
Treatment
Antimicrobial therapy is the treatment of choice.
BIBLIOGRAPHY
- DeCroos FC, Garg P, Reddy AK, et al. Optimizing diagnosis and management of nocardia keratitis, scleritis, and endophthalmitis: 11 year microbial and clinical overview. Ophthalmology.2011;118:1193-200.
- Greenfield RA. (2011). Nocardiosis. [online] Available from www.emedicine.com/med/TOPIC1644.HTM. [Accessed July, 2013].
37. PAPPATACI FEVER (PHLEBOTOMUS FEVER; SANDFLY FEVER)
General
Viral etiology; transmitted by the sandfly Phlebotomus papatasii.
Ocular
Pick sign of conjunctiva (conjunctival injection limited to the exposed portion of the conjunctiva); uveitis; optic neuritis; papilledema; papillitis; blepharospasm; retinal venous engorgement; vitreal exudates.
Clinical
Fever; headaches; myalgia; pain; stiffness of the neck and back.
Laboratory
Parasite can be detected through direct evidence from peripheral blood, bone marrow, or splenic aspirates.
Treatment
Sodium stibogluconate, a pentavalent antimonial compound (SbV), is the drug of choice.
BIBLIOGRAPHY
- Vidyashankar C, Agrawal R. (2011). Pediatric Leishmaniasis. [online] Available from www.emedicine.com/ped/TOPIC1292.HTM. [Accessed July, 2013].
38. PHARYNGOCONJUNCTIVAL FEVER (ACUTE FOLLICULAR CONJUNCTIVITIS; ADENOVIRAL CONJUNCTIVITIS; SYNDROME OF BEAL)
General
Infectious disease produced by adenovirus; serotypes 3, 4, 7, 8, 19, 37, and several others may cause acute conjunctivitis with or without upper respiratory tract involvement; epidemic keratoconjunctivitis has been reported worldwide associated with 11 virus serotypes, with serotypes 8, 11, and 19 being the most commonly responsible.
Ocular
Conjunctivitis; chemosis; keratitis; blepharitis; blepharospasm.
Clinical
Fever; pharyngitis; lymph node enlargement; malaise; myalgia; headache; diarrhea.
Laboratory
Laboratory tests generally are not useful. Cell cultures from infected areas and adenoviral antibody titer allows for precise identification of serotype.
Treatment
Symptomatic control may include cold compresses, artificial tears; nonsteroidal and occasionally steroidal drops to relieve itching.
BIBLIOGRAPHY
- Scott IU. (2012). Pharyngoconjunctival Fever. [online] Available from www.emedicine.com/oph/TOPIC501.HTM. [Accessed July, 2013].
39. PNEUMOCOCCAL INFECTIONS (STREPTOCOCCUS PNEUMONIAE INFECTIONS)
General
Gram-positive diplococcus Streptococcus pneumoniae; some strains are encapsulated while others are not; ocular infections usually are caused by the encapsulated strains; conjunctivitis and corneal scarring produced in an animal model have been attributed to a hemolytic cytolytic exopeptidase.
Ocular
Hypopyon; conjunctivitis; keratitis; corneal ulcer; endophthalmitis; dacryocystitis; uveitis; orbital cellulitis; secondary glaucoma; ophthalmia neonatorum.
Clinical
Upper respiratory infection; chills; sharp pain in hemithorax; cough with sputum production; fever; headache; gastrointestinal symptoms.
Laboratory
Gram stain demonstrates Gram-positive cocci in pairs. The unattached end of each cocci is slightly pointed outward.
Treatment
Impetigo, oral antibiotics and topical antibiotic ointment; preseptal cellulitis, oral antibiotics; orbital celluliti, need team of infectious diseases, otolaryngology and ophthalmology to develop plan of therapy; dacryocystitis, oral and topical antibiotics, dacryocystorhinostomy may be necessary; conjunctivitis, topical antibiotic; keratitis, topical antibiotics; poststreptococcal reactive arthritis can occur with uveitis, topical steroids and cycloplegics; endophthalmitis, prompt and aggressive therapy with topical, intravitreal and sometimes systemic antibiotics and pars plana vitrectomy; post-refractive surgery keratitis, flap raised, cultured and treated. Occasionally the flap should be amputated.
BIBLIOGRAPHY
- Muench DF. (2012). Pneumococcal Infections. [online] Available from www.emedicine.com/med/TOPIC1848.HTM. [Accessed July, 2013].
40. PRESUMED OCULAR HISTOPLASMOSIS (HISTOPLASMOSIS CHOROIDITIS; HISTOPLASMOSIS MACULOPATHY; HISTOPLASMOSIS SYNDROME)
General
Fungal infection caused by Histoplasma capsulatum.
Ocular
Circumpapillary atrophy; maculopathy; scattered yellow “histo” spots; optic disk edema; disseminated choroiditis (immunocompromised patients); vitreous hemorrhage; punched-out chorioretinal lesions; choroidal neovascular membrane; exogenous endophthalmitis (isolated report).
Clinical
Pulmonary infection; fever; malaise.
Laboratory
Sixty percent of the adult population from the Ohio and Mississippi river valleys have a positive histoplasmin skin test; therefore clinic course is most helpful.
Treatment
Although the diagnosis is clinical, certain ancillary tests help in confirming it. Fluorescein angiography, human leukocyte antigen (HLA) typing B7 and DRw2 may be indicated.
BIBLIOGRAPHY
- Wu L. (2012). Presumed Ocular Histoplasmosis Syndrome. [online] Available from www.emedicine.com/oph/TOPIC406.HTM. [Accessed July, 2013].
41. PROPIONIBACTERIUM ACNES
General
Gram-positive, pleomorphic, non-spore forming bacillus that is considered part of the normal eyelid and conjunctival anaerobic flora. Pathogenic if introduced intraocular.
Clinical
None
Ocular
Chronic keratitis, endophthalmitis, vitritis.
Laboratory
Aerobic and anaerobic cultures must be incubated for 14 days. Capsular biopsy may demonstrate Gram-positive, pleomorphic, non-spore forming bacillus or Gram stain.
Treatment
Vancomycin, intravitreal or systemic
BIBLIOGRAPHY
- Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder's Current Ocular Therapy, 6th edition. London: Elsevier; 2008.
42. PROTEUS INFECTIONS
General
Gram-negative bacilli found in water, soil and decaying organic substances.
Ocular
Conjunctivitis; keratitis; corneal ulcers; endophthalmitis; panophthalmitis; dacryocystitis; gangrene of eyelid; uveitis; hypopyon; paralysis of seventh nerve.
Clinical
Cutaneous infection after surgery; usually occurs as a secondary infection of the skin, ears, mastoid sinuses, eyes, peritoneal cavity, bone, urinary tract, meninges, lung, or bloodstream; meningitis; intracranial subdural and epidural empyema; brain abscess; intracranial septic thrombophlebitis affecting cavernous/lateral sinuses.
Laboratory
Proteus organisms are easily recovered through routine laboratory cultures. An ultrasound of the kidneys or a CT scan should be considered as part of a workup.
Treatment
Traditional treatment includes oral quinolone for 3 days or trimethoprim/sulfamethoxazole.
BIBLIOGRAPHY
- Struble K. (2011). Proteus Infections. [online] Available from www.emedicine.com/med/TOPIC1929.HTM. [Accessed July, 2013].
43. PROTEUS SYNDROME
General
A harmarteo neoplastic disorder with variable clinical manifestations.
Ocular
Myopia; band keratopathy; cataract; vitreous hemorrhage; chorioretinal mass; serous retinal detachment.
Clinical
Thickening of the bones of the external auditory meatus and cranial fossa; enlargement of the left internal auditory meatus; deformities of the feet and toes.
Laboratory
Proteus organisms are easily recovered through routine laboratory cultures. An ultrasound of the kidneys or a CT scan should be considered as part of a workup.
Treatment
Traditional treatment includes oral quinolone for 3 days or trimethoprim/sulfamethoxazole.
BIBLIOGRAPHY
- Struble K. (2011). Proteus Infections. [online] Available from www.emedicine.com/med/TOPIC1929.HTM. [Accessed July, 2013].
44. PSEUDOMONAS AERUGINOSA INFECTIONS
General
Gram-negative rod with secondary contaminant of superficial wounds; Pseudomonas organisms produce a variety of enzymes that cause pathologic changes, including hemolysins and exotoxins as well as a glycocalyx that increases adherence.
Ocular
Hypopyon; conjunctivitis; keratitis; ulcerative abscess of cornea; endophthalmitis; panophthalmitis.
Clinical
Local tissue damage and diminished host resistance, which may occur in ear, lung, skin, and urinary tract.
Laboratory
Complete blood count may reveal leukocytosis with a left shift and bandemia. Positive results on blood culture in the absence of extracardiac sites of infection may indicate pseudomonal endocarditis.
Treatment
Antimicrobials are the mainstay of therapy. Two-drug combination therapy such as an antipseudomonal beta-lactam antibiotic with an aminoglycoside.
BIBLIOGRAPHY
- Klaus-Dieter L. (2012). Pseudomonas aeruginosa Infections. [online] Available from www.emedicine.com/med/TOPIC1943.HTM. [Accessed July, 2013].
45. Q FEVER (COXIELLA BURNETII)
General
Acute rickettsial infection caused by Coxiella burnetii; at least eleven serotypes of this organism are capable of causing human infection; elevated inflammatory response results in granulomatous formation.
Ocular
Conjunctivitis; gangrene of eyelids; retinal hemorrhages; perivasculitis; episcleritis; optic neuritis; uveitis; papilledema; nystagmus; ocular motor nerve pareses; Miller-Fisher syndrome.
Clinical
Fever; severe headache; tissue necrosis; pneumonia; self-limited fever; endocarditis; hepatitis.
Laboratory
Small Gram-negative rod which grows inside eukaryotic cells. Diagnosis is made based on detection of phase I and II antibodies a four fold rise in complement-fixing antibody titer against phase II antigen occurs and yields the highest specificity.
Serologic test
Compliment fixation is specific but lacks sensitivity and indirect immunofluorescence is Q fever highly specific and sensitive.
Treatment
Adequate antibiotic therapy initiated early in the first week of illness is highly effective and is associated with the best outcome. Doxycycline is the drug of choice.
BIBLIOGRAPHY
- Rathore MH. (2011). Rickettsial Infection. [online] Available from www.emedicine.com/ped/TOPIC2015.HTM. [Accessed July, 2013].
46. RABIES (HYDROPHOBIA; LYSSA)
General
Acute viral zoonosis of the central nervous system.
Ocular
Lid retraction; widening of palpebral fissure; retinal hemorrhages; mydriasis; paralysis of third, fourth, fifth, or seventh nerve; bilateral optic neuritis; branch retinal artery occlusion; vaccine-induced autoimmune demyelinative optic neuritis.
Clinical
Fever; headache; nausea; numbness; tingling; acute sensitiveness to sound and light; laryngeal and pharyngeal spasms; increased muscle tonus; convulsions; delirium; coma; death.
Laboratory
Saliva can be tested by virus isolation or reverse transcription followed by PCR. Suspected infectious animal should be quarantined for 10 days.
Treatment
Before the onset of symptoms, both passive and active immunizations are effective for preventing progression to full-blown rabies. In exposures to high-risk species, initiate treatment immediately pending laboratory examination of the animal, if it is caught.
BIBLIOGRAPHY
- Gompf SG. (2011). Rabies. [online] Available from www.emedicine.com/med/TOPIC1374.HTM. [Accessed July, 2013].
47. RHINOSPORIDIOSIS
General
Rare fungal infection, primarily affecting the mucous membranes of the nose and eye. Causative agent is Rhinosporidium seeberi.
Clinical
Respiratory mucosa, vaginal mucosa, skin and metastatic-like involvement of the internal organs.
Ocular
Conjunctival lesions, photophobia and conjunctival infection.
Treatment
Complete surgical excision remains the most effective treatment. Cautery or cryopexy to the base of the excised lesion may be beneficial to prevent recurrence.
BIBLIOGRAPHY
- Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder's Current Ocular Therapy, 6th edition. London: Elsevier; 2008.
48. ROCKY MOUNTAIN SPOTTED FEVER
General
Acute systemic disease caused by Rickettsia rickettsii transmitted by a wood tick or dog tick.
Ocular
Conjunctivitis; optic atrophy; cotton-wool spots; scotoma; uveitis; optic neuritis; paralysis of accommodation; paralysis of extraocular muscles; retinal vascular occlusion; vitreal opacity; hypopyon; anterior uveitis with fibrin clots.
Clinical
Fever; chills; headache; muscle aches; rash.
Laboratory
Early diagnosis depends on clinical and epidemiologic grounds. Polymerase chain reaction has high sensitivity and specificity.
Treatment
Intravenous tetracycline and chloramphenicol should be started as soon as possible. Oral doxycycline, tetracycline and chloramphenicol may be considered but only if patient is not acutely ill.
BIBLIOGRAPHY
- Cunha BA. (2011). Rocky Mountain Spotted Fever. [online] Available from www.emedicine.com/oph/TOPIC503.HTM. [Accessed July, 2013].
49. RUBELLA SYNDROME (CONGENITAL RUBELLA SYNDROME; GERMAN MEASLES; GREGG SYNDROME)
General
Rubella infection of the mother during first trimester of pregnancy; ocular disease is the most commonly found abnormality in patients with congenital rubella syndrome (75%), multiorgan disease is common (> 75%); no significant association has been found between gestational age and time of maternal infection and incidence of individual ocular conditions.
Ocular
Nystagmus; glaucoma; corneal haziness; cataracts; retinal pigmentary changes; appearance and central distribution of lesions are quite distinguishable from retinitis pigmentosa; retinopathy is not progressive and has little, if any, effect on vision; waxy atrophy of optic disk; conjunctivitis; megalocornea or microcornea; buphthalmos; microphthalmos; uveitis; iris atrophy; spherophakia; strabismus.
Clinical
Low-birth weight; diarrhea; pneumonia; urinary infection; hearing loss; heart disease; hepatosplenomegaly; mental retardation; inguinal hernias; ataxia; cardiac abnormalities.
Laboratory
Diagnosis is made by clinical findings. If in doubt, a rising titer of immunoglobulin M will indicate a recent infection.
Treatment
Treatment for rubella of the eye centers on glaucoma and cataract.
BIBLIOGRAPHY
- Lombardo PC. (2011). Dermatologic Manifestations of Rubella. [online] Available from www.emedicine.com/derm/TOPIC380.HTM. [Accessed July, 2013].
50. RUBEOLA (MEASLES; MORBILLI)
General
Acute, extremely communicable disease that affects young school-aged children; caused by paramyxovirus.
Ocular
Hypopyon; uveitis; conjunctivitis; Koplik (Hirschberg) spots of conjunctiva; keratitis; corneal ulcer; cellulitis of lid; dacryocystitis; congenital cataract; optic atrophy; optic neuritis; strabismus; pigmentary retinopathy; iris prolapse; hemianopsia; secondary glaucoma; central retinal artery occlusion; orbital cellulitis; accommodative spasm; paralysis of sixth nerve; keratoconus.
Clinical
Maculopapular rash; fever.
Laboratory
Diagnosis made by clinical findings.
Treatment
Good hydration.
BIBLIOGRAPHY
- Chen SSP. (2011). Measles. [online] Available from www.emedicine.com/derm/TOPIC259.HTM. [Accessed July, 2013].
51. SPOROTRICHOSIS
General
Chronic fungal infection caused by Sporothrix schenckii; lesion usually occurs on exposed skin and is characterized by nodules or pustules that may develop into small ulcers; infectious agent usually gains entrance into the skin by traumatic implantation of soil or plant materials; disseminated sporotrichosis is uncommon, usually occurring in alcoholics or immunosuppressed patients.
Ocular
Conjunctivitis; keratitis; corneal ulcer; blepharitis; endophthalmitis; iris atrophy; dacryocystitis; osteitis; periosteitis; scleritis; erosion of bony walls of the orbit.
Clinical
Enlargement of regional lymph nodes; pulmonary lesions; granulomas in the joints and genitourinary system.
Laboratory
Cultured on Sebouraud dextrose agar, cream-colored to black, folded, leathery.
Treatment
Potassium iodide drops as a saturated solution is the treatment of choice. Amphotericin B may be necessary in more severe forms with visceral and intraocular or orbital involvement.
BIBLIOGRAPHY
- Greenfield RA. (2012). Sporotrichosis. [online] Available from www.emedicine.com/med/TOPIC2161.HTM. [Accessed July, 2013].
52. STAPHYLOCOCCUS
General
Gram-positive coccus Staphylococcus aureus; most common cause of suppurative infection in humans; more common in patients with a previous disorders, such as diabetes, thyroid disease, renal failure, or malnutrition; although most S. aureus isolates from other sources are encapsulated, capsules have not been noted in ocular isolates.
Ocular
Uveitis; hypopyon; conjunctivitis; keratitis; cellulitis of lid; meibomianitis; ptosis; blepharitis; endophthalmitis; dacryocystitis; increased intraocular pressure; orbital periosteitis.
Clinical
Tissues hypertonic, edematous, and painful; lesion liquefies, forming creamy yellow pus; fever; nausea; vomitng; ccough; dyspnea; abdominal pain; diarrhea; bloody stools; dehydration; shock.
Laboratory
Aerobic Gram-positive cocci bacteria grow in grape-like clusters. Coagulase positive indicates pathogenicity.
Treatment
Specific antimicrobial therapy is chosen based on the site and severity of the infection and the antimicrobial sensitivities of the organism involved.
BIBLIOGRAPHY
- Tolan RW. (2012). Staphylococcus Aureus Infection. [online] Available from www.emedicine.com/ped/TOPIC2704.HTM. [Accessed July, 2013].
53. STREPTOCOCCUS (SCARLET FEVER)
General
Gram-positive bacteria that can invade any tissue.
Ocular
Conjunctivitis; corneal ulcer; blepharitis; scarlatinal rash of lid; erysipelas dermatitis of lid; gangrene of lid; endophthalmitis; proptosis; dacryocystitis; optic neuritis; orbital cellulitis; uveitis; hypopyon; secondary glaucoma; paralysis of extraocular muscles; infectious crystalline keratopathy; scleritis.
Clinical
Pharyngitis; impetigo; scarlet fever; pneumonia; bacteremia; rheumatic fever; glomerulonephritis.
Laboratory
Gram-positive cocci growing in pairs or chains. Throat culture and sensitivity are useful.
Treatment
Penicillin is the drug of choice.
BIBLIOGRAPHY
- Zabawski EJ. (2011). Scarlet Fever. [online] Available from www.emedicine.com/emerg/TOPIC518.HTM. [Accessed July, 2013].
54. SYPHILIS (ACQUIRED LUES; ACQUIRED SYPHILIS; LUES VENEREA; MALUM VENEREUM)
General
Causative agent, Treponema pallidum, usually transmitted sexually.
Ocular
Conjunctival chancroid; conjunctivitis; keratitis; blepharitis; ptosis; iris atrophy; hippus; dacryocystitis; optic nerve atrophy; optic neuritis; periostitis; episcleritis; scleritis; nystagmus; uveitis; vitreous hemorrhages; paralysis of sixth nerve; papilledema; retinal hemorrhages; retinitis proliferans; oculogyric crisis; neuroretinitis; papilledema (associated with aseptic meningitis); diffuse or multifocal chorioretinitis; vertical supranuclear gaze palsy; Benedikt syndrome.
Clinical
Primary lesion associated with regional lymphadenopathy; secondary bacteremic stage associated with generalized mucocutaneous lesions; tertiary stage characterized by destructive mucocutaneous, musculoskeletal, or parenchymal lesions, aortitis, or central nervous system disease; syphilis and human immunodeficiency virus (HIV) infection often coexist in the same patient who experiences a higher incidence and greater severity of neurologic and ocular manifestations; a significant percentage of patients infected with HIV-I and T. pallidum become seronegative to syphilis testing.
Laboratory
Serologic nontreponemal tests include Venereal Disease Research Laboratory (VDRL) and rapid plasma reagin (RPR).
Treatment
The goals are to reduce morbidity and to prevent complications. Penicillin is the antibiotic of choice for treating syphilis. Ocular syphilis should be treated the same as patients with neurosyphilis.
BIBLIOGRAPHY
- Majmudar PA. (2011). Interstitial Keratitis Overview of Interstitial Keratitis. [online]. Available from www.emedicine.com/oph/TOPIC453.HTM. [Accessed July, 2013].
- Euerle B. (2012). Syphilis. [online] Available from www.emedicine.com/med/TOPIC2224.HTM. [Accessed July, 2013].
55. SYPHILIS, CONGENITAL (CONGENITAL LUES)
General
Caused by intrauterine transplacental infection of fetus by T. pallidum (see Syphilis).
Ocular
Conjunctivitis; keratitis; dacryocystitis; optic nerve atrophy; periostitis; anisocoria; Argyll Robertson pupil; retinal degeneration; nystagmus; gumma of conjunctiva, eyelids, and orbit; paresis of extraocular muscles; secondary glaucoma; uveitis; iridoschisis.
Clinical
Cutaneous and mucous membrane lesions; periostitis; anemia; hepatosplenomegaly; ectodermal defects; central nervous system involvement; gummatous lesions.
Laboratory
Fluorescent treponemal antibody-absorption (FTA-ABS) and microhemagglutination assay for Treponema pallidum (MHA-TP) are the standard test. All patients with syphilis should also be tested for HIV.
Treatment
Parenteral penicillin is the preferred treatment for all stages of syphilis. The treatment varies from primary and secondary syphilis, late latent syphilis, tertiary syphilis and neurosyphilis. Ocular treatment includes topical steroids and cycloplegics and it can relieve the symptoms of anterior uveitis and interstitial keratitis. Subconjunctival steroids have been used to relieve recurrent anterior segment inflammation. Severe corneal opacification may require keratoplasty; however, with recurrent inflammation and graft rejection.
BIBLIOGRAPHY
- Waseem M. (2011). Pediatric Syphilis. [online] Available from www.emedicine.com/ped/TOPIC2193.HTM. [Accessed July, 2013].
56. TETANUS (LOCKJAW)
General
Acute infectious disease affecting nervous system; causative agent is Clostridium tetani; bacteria enters body through a puncture wound, abrasion, cut, or burn.
Ocular
Chemosis; keratitis; nystagmus; uveitis; corneal ulcer; cellulitis of orbit; hypopyon; panophthalmitis; pupil paralysis; pseudoptosis; blepharospasm; paralysis of third or seventh nerve; may occur following perforating ocular injuries.
Clinical
Severe muscle spasms; dysphagia; trismus; facial palsy; muscle stiffness; irritability.
Laboratory
Gram-positive spore-forming bacteria; laboratory studies are of little value.
Treatment
Passive immunization with human tetanus immune globulin shortens the course of tetanus and may lessen its severity. Benzodiazepines have emerged as the mainstay of symptomatic therapy for tetanus.
BIBLIOGRAPHY
- Hinfey PB. (2012). Tetanus. [online] Available from www.emedicine.com/med/TOPIC2254.HTM. [Accessed July, 2013].
57. TRACHOMA
General
Most common in rural communities of the Middle East, Africa, Asia, and South and Central America; caused by C. trachomatis; associated with poor sanitation and medical care.
Ocular
Chronic keratoconjunctivitis; papillae follicles; keratitis; opacities of cornea; scars of palpebral conjunctiva; ptosis; tearing; entropion.
Clinical
Rhinitis; otitis media; upper respiratory tract infection.
Laboratory
Most endemic areas, lab tests are unavailable. Commercial PCR based assay has high sensitivity and specificity.
Treatment
Tetracycline eye ointment for 6 weeks or a single dose azithromycin systemically.
BIBLIOGRAPHY
- Solomon AW. (2011). Trachoma. [online] Available from www.emedicine.com/oph/TOPIC118.HTM. [Accessed July, 2013].
58. TUBERCULOSIS
General
Communicable disease caused by the acid-fast bacillus Mycobacterium tuberculosis.
Ocular
Conjunctivitis; subconjunctival nodules (tuberculomas); keratitis; pannus; corneal ulcer; blepharitis; cellulitis; meibomianitis; uveitis; dacryocystitis; chronic orbital cellulitis; retinitis; scleritis; scleral perforation; hypopyon; vitreous hemorrhages; optic neuritis; optic atrophy; tuberculous panophthalmitis; choroidal tubercles; intraorbital extraocular lesions.
Clinical
Pulmonary infection; pyuria; hematuria; epididymitis; dysuria; flank pain; distorted calyces; productive cough.
Laboratory
Acid-fast bacillus culture of body fluids including vitreous and aqueous. Polymerase chain reaction is 89% positive for pulmonary infection.
Treatment
A course of chemotherapy (isoniazid, rifampin, pyrazinamide and ethambutol or streptomycin) for a period of 6 months is the recommended therapy.
BIBLIOGRAPHY
- Collins JK. Handbook of Clinical Ophthalmology. New York: Masson; 1982.
- DeVoe AG, Locatcher-Khorazo D. The external manifestations of ocular tuberculosis. Trans Am Ophthalmol Soc.1964;62:203-12.
- D’Souza P, Garg R, Dhaliwal RS, et al. Orbital tuberculosis. Int Ophthalmol.1994;18:149-52.
- Gupta V, Gupta A, Arora S, et al. Presumed tubercular serpiginous like choroiditis. Ophthalmology. 2003;110: 1744-9.
- Patkar S, Singhania BK, Agrawal A. Intraorbital extraocular tuberculosis: a report of three cases. Surg Neurol. 1994; 42:320-1.
- Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder's Current Ocular Therapy, 6th edition. London: Elsevier; 2008.
- Tejada P, Mendez MJ, Negreira S. Choroidal tubercles with tuberculous meningitis. Int Ophthalmol.1994;18:115-8.
59. TYPHOID FEVER (ABDOMINAL TYPHUS; ENTERIC FEVER)
General
Causative agent, Salmonella typhi.
Ocular
Conjunctivitis; chemosis; corneal ulcer; tenonitis; paralysis of extraocular muscles; endophthalmitis; panophthalmitis; optic neuritis; retinal detachment; central scotoma; central retinal artery emboli; iritis with or without hypopyon; choroiditis; retinal hemorrhages; bilateral optic neuritis; abnormal ocular motility (likely secondary to thrombotic infarcts affecting the ocular motor nerve nuclei, fascicles, brainstem, or cerebral hemispheres).
Clinical
Fever; headache; bradycardia; splenomegaly; maculopapular rash; leukopenia; encephalitis. Salmonella may produce an illness characterized by fever and bacteremia without any other manifestations of enterocolitis or enteric fever, which is particularly common in patients with acquired immunodeficiency syndrome (AIDS).
Laboratory
Gram-negative bacillus isolation from blood culture (50-70% of cases). Positive stool culture is less frequent.
Treatment
Early detection, antibiotic therapy and adequate fluids, electrolytes, and nutrition reduce the rate of complications and reduce the case-fatality rate.
BIBLIOGRAPHY
- Brusch JL. (2011). Typhoid Fever. [online] Available from www.emedicine.com/med/TOPIC2331.HTM. [Accessed July, 2013].28
60. VARICELLA (CHICKENPOX)
General
Acute exanthematous disease; highly contagious; children ages between 2 and 8 years.
Ocular
Conjunctival ulcer; corneal ulcer; descemetocele; corneal opacity; keratitis; paresis of third, fourth, and sixth nerves; optic neuritis; papilledema; retinitis; hemorrhagic retinopathy; uveitis; cataract; paralytic mydriasis; phthisis bulbi; unifocal choroiditis; dendritic keratitis; acute retinal necrosis (in a patient with AIDS); disciform keratitis.
Clinical
Fever; malaise; rash; pruritus.
Laboratory
Diagnosis is made by clinical findings.
Treatment
Isolation oral antihistamines, such as diphenhydramine and hydroxyzine, are used for severe pruritus and acetaminophen is recommended for use for the reduction of fever.
BIBLIOGRAPHY
- Bechtel KA. (2011). Pediatric Chickenpox. [online] Available from www.emedicine.com/emerg/TOPIC367.HTM. [Accessed July, 2013].
61. VARICELLA SYNDROME, CONGENITAL
General
Varicella passed in utero from mother to fetus.
Ocular
Microphthalmia; microcornea; persistent hyperplastic primary vitreous.
Clinical
Urinary tract infection; neurogenic bladder.
Laboratory
Clinical.
Treatment
See persistent hyperplastic primary vitreous.
BIBLIOGRAPHY
- Anderson WE. (2011). Varicella-Zoster Virus. [online] Available from www.emedicine.com/med/TOPIC2361.HTM. [Accessed July, 2013].
62. YERSINIOSIS
General
Infection with one of the invasive rod-shaped Yersinia bacteria.
Clinical
Gastroenteritis, high fever, acute terminal ileitis.
Ocular
Corneal perforation, panophthalmitis, anterior uveitis, photophobia, lacrimation, pericorneal ciliary injection, aqueous flare and cell, keratic precipitates and macular edema.
Laboratory
Small, non-motile, Gram-negative coccobacilli found in stool samples and conjunctiva.
Treatment
Tetracycline or chloramphenicol is drug of choice.
BIBLIOGRAPHY
- Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder's Current Ocular Therapy, 6th edition. London: Elsevier; 2008.