Ocular Infections in My PracticeDovchinjamts Dagvadorj, M.D.

Financial disclosure

• No financial interest

• Lid

• Conjunctiva

• Orbital adnexa

Common ocular infection sites

• Cornea

• Vitreous

• Retina/Choroid

• Optic nerve

Defense mechanism

•Blood ocular barrierCorneal epithelium

Vessel endothelium

Retinal pigment epithelium

• Immune mechanism Innate immunity

ACAID /anterior chamber associated immune deficiency/

Infectious organisms

•Bactery

•Fungus

•Virus

•Parasites

Bacterial infection

• Common sight-threatening condition

• Keratitis

• Endophthalmitis

• Uveitis

• Optic neuritis

• Contact lens wear

• Trauma

• Surgery

• Contaminated ocular medication

• Impaired defense mechanisms

• Altered structure of the corneal surface

Common bacterial isolates

Case presentation

Case 1

• 26 years old healthy man

• Painful visual loss in the right eye ~ 4 days

• Small piece of ceramic got into his right eye during cutting the ceramic board.

• Went to local eye clinic and received local Dexamethasone injection for 2 times.

1st day

Right Left

A/C: mild cellular reaction

Deep stromal

infiltration

Impression: Infectious Keratitis

Management:

1. Stop steroid

2. Local Cefazolin injection

3. Moxifloxacin q 2 hour

4. Levofloxacin eye ointment

2nd day

Right

A/C: severe cellular reaction

Deep stromal

infiltration

worsened

Management:

1. Corneal scrape

2. Swab for culture

3. Moxifloxacin q 1 hour

Hypopion

Corneal scrape

1. Get rid of infection

2. Increase penetrance of medication

3. Identify organism by gram stain,

culture

Lab result

Management:

1. Local Vancomycin

injection

2. Fortified vancomycin

eye drop q 1 hour

3. Tetracycline eye

ointment

After selected ATB therapy

After

moderate cellular reaction

Deep stromal

infiltration

improved

No hypopion

A/C: severe cellular reaction

Deep stromal

infiltration

Hypopion

Before

Case 2

• 71 years old women with Hypertension

• Painful visual loss in the right eye 1 day

• Cystoid Macular Edema from Retinal Vein Occlusion

• Intravitreal anti-VEGF injection – Bevacizumab

1st day Photo will be attached

Left

A/C: severe cellular reaction

Hypopion

Impression & Management

• Exogenous Endophthalmitis Left Eye

• Set Vitreous tapping + IVT ceftazidime & vancomycin

• Vitreous for culture

4th day

Vitreous tapping

1. Inoculate the organism

Intravitreal ATB

1. Cover gram + / –

2. Appropriate concentration

3. No ocular toxicity

4. 48 – 72 hours

A/C: moderate cellular reaction

No hypopion

Lab result• IVT ceftazidime

1st vs 4th day

After ATB

4th day 9th day 21th day

Case 3

• 20 years old healthy man

• Painless visual loss in the left eye ~ 7 days

• No trauma, surgery, contact lens wear

• Family history - negative

Eye finding Photo will be attached

Impression :

1. Neuroretinitis

2. Secondary Branch Retinal Vein Occlusion

Differential diagnosis

1. Presumed ocular tuberculosis

2. Ocular syphilis

3. Diffuse Unilater Subacute Neuroretinitis

(Nematode)

4. Antiphospholipid Syndrome

Laboratory investigation

• CBC

• ANA, CRP

• VDRL, RPR

• Mantoux test

• Chest X-Ray

RPR 1:2

VDRL reactive

Unsafe sexual intercourse 1 years ago

Tertiary Syphilis

Treatment

• IV Penicillin G 18 – 24 MU 10 to 14 days

• IM Procaine Penicillin G 2.4 MU q 3 weeks

Before & after treatment

1st visit 7 days 14 days

Thank you for your attention!