. , t . :

E.T INIFIECTtrONS

Dr. Banumathi GurusamyHospital Pulau Pinang

ey Di:&n!tufr @osa PP

Lid,,trnf,ee.ti:ofls'. Stye (External Hordeolum)

- Suppurative inflarhation oflash follicleandiits associaledglad,dzeis o4 Mbtl.

- Cause{bioagglasb,PbssidVeStaphylococcus.

) Clinical feahues:- Acute Bain,in fi e,Iid lnuin- Tender inflained swelling bver the lid marginwith pus, poiifi ng..rantdiorr!$tlirougb: the skin

By D. hdDbi tu'Mdy PP 2

Stye' Treatrnent. Warm compress.. Antibiotics (systemic/ local).. Surgical Incision:& Curettage-

Ir.ItefiI :F{orde"o-funInternatr,L{ordeolum

. Small Abscess caused by an,acute.

, .staphl occalinf,ectionofmeibomian gl.

, GliirfualFgatureS:: >llerra'"r i"Ilarneii swellingr*ithih,tarsal

plate.) More painful than stye.) Lesion enlarge & discharge pus either

po$terictrly through conjunctiva or

Intemgl Hor,de olum- Treatment. : i : . , . . ; t i , ; . . : . :

. WarmGompress.I Antiotiibtibr( Systemic/rlbcal), :. Surgrcal Incision & Curettage.

ByD.&Mdi&ruq,W

Chal azi'on (Me'iborn'ian Cyst). Ctronic irifi4$.lAtpryliFogr4l*ilornatous lesion.. Clinical.Features:

- Painless slowly enlarging.firm lesion inthe tarsal plate.

- No signs of inflamation

. Pathology:Lowcrtlnfectioi .

:' obstructim ofdit6

IAauinrili!ffi .of meipomft45eoaion

8iDj&dmli;tuym I

eyu. r';iticiry, rn

Chalazion - Treatement

Xrtoi,sion andCurettage

' :Chliazion -,Trea-tement

. i

. Incisionr and' Curettage

. Antibiotic ointment

. Conilr'lidations:-)iMechaiiical'ptosis.with rAsti gmatism>,fni i t l 'o . e

,

t , : , ' , , , r : , , , : ,

.) Rlrre.,-:.Mbi$ornian.ea. " r

8y D. &@ndi eNrry, HPP

ts@hari,tisV

Blepharitis

Orbital& Pteseptal Cellu'litis(more-common in chiltlren)

B:tepharitis. ChronicinflAmation of litirmar,:gfn;

) Staph. Blepharitis. .

) Se,borrhoei-C Blgpharitid. Clinical fbatures:

)lnitation &buming sensation ovei lid marein)Brinle scales-clinging to the lashes)Triiy:u'lpefatedr#ex (staptr,B,t+ iris)

. Treatrnent:)Lid hygeine)Antitistic ointpent ,) TOpiCalSterd65.aloionrnu,.rer . rJ

Orb,ital Cellulitis. Infection'process Bostedor to the orbital

septum.thal qffects the,orbital contents.. Extension of infection from nasopharynx or

per,anas i;iiiu .psn gtlUuoidAl,. Age group: Children & young adults. Causalivg r,gahisnasr,;stiep. Pneurnoniae,

Strep. Pyogengs, staph. Aureous, H.Influenzae (< 5 years).

By &. hilfrioru.Dy H PP ts

Orbital C ellulitis- Complicationsl,,Cavernog,,sr sinrlgr,thrombosis.2. Meningitis 'i.'elteu#'rtus i ' '4. Central retinal artery occlusion l.

l l5, Optic lrewejnflaitnation) optic atrophy I

' l

,

lpfoilBi*ryiru:aoov;,gPr, ' ll

Orb:ital Cellulitis (conr)' Clinical features:

) Severe pain with marked swelling of thel ids

) Conjuctiv4l chemosis 4nd congestion) Proplosis-ofrhe globe) Limitation of 'extraoau.lar.movements

with diplopia) Impairment of pupillary reaction with

deereased visioil.bilBdn.si6d;@.Pil b

Orbital Cellulitis

Orbital Cellulitis

ay&.i'l|*situx'sP B

Orbital cellulitis- Treatrnent

l.Invqstigatims: .:)ESR., WBC) X-Ray paranasalsinuses.)CT Scan

2. ENT refenal3. IV antibiotics4, Drain tlie orbit as well:as the infected sinuses.

ByD hFnthituXpP

I Lacrinnal Systern

4r.athtlt pi lecri*i ,lJuilr4$r iu.tit:er

.frrrpulfu (Z orrrrf

Infection of Lacrir,nal System

Canaliculiti s- inf,ection of,'lacritnalcanalieuli)Chronic- caused, b;r: aotinonrlrees:israelii)Acute caused by.herpgs'sirnplex infection

or fungal infection, Eg: Candida)Treatment:

- Removerttieobstructive ooncretions- Treat with penicillin G. solution/

nystatin drops'.ayftiBrdryl|itu!4}HPl 6

Daeryoeytitis

Dacryocytitis- Adult onset (cont). Clinical features

) Epiphora) Regurgitation of mucous materials on presswe

over medial:canthus.)l Syringing

-

bfodked nasolairimalr duct. Treatment:

) Hydiostatic massage with repeated qyringing.) Surgery- Dacryocystorhinostomy (DCR)

Dacryocytitis-,A.dult onset. Chronic D'aoryoqylitis

>NtiaUie ,g" Z,S fetniate ' ',:. predlsp $ffifs,,, '

tt ,

:.

),g*,n"t6 6g1;lajirtli.nAtafse-p-tlrr-l ')xasa1 polp,"'.t,r ' :)Hypertrophied :inferior turbinates.)Traurna.\:

'

ry'y'1a-n't**'

'Dacryoc, -stitis, (indbotion of lacrinral

sac). Congenital- failure of canalisation of nasolacrimal

duct.. Clinical featwes:

)Epiplrp;q : . .) Rgfiu4'otpurulqntEaterialsrVhen .pressed.over the medial: canthus;

. Treatmerit:r=-.-...''-:l. Hydrostatic.massage2. Ant$.ioJie.s3. hobing (6 montls and I year)4. Surgp1,y;,Eaqp9pytqhliao$hny z7

Acute Dacryocystitis. Acute,exacerbatibn of chronic Dacryocysitis. Clinical features:

) pain, retress. and swelling ovei lacriiiral .sac area.) P.unrlent discharge from the punctum) F,ever,

. Treatment:) Hot compresV systemic antibiotic) Aspirate the pus witlr wide bore needle,

, @q I &D,to,avoid fstula for.mation;),:#, :Pian:forDCR;

ry.D. hn.il:oilrd$ W 3t

Acute Dacryocy,stitis

Acute Ih,fect'ious Dacw oad enitis. Infection.of lacrimal gland,. Clinical foatures:

) Pain, redness, swelling over the outer onethird ofthe upper eye lid.

) Common in young people.) Caused by acute infection such as Staph.

or FI.. Influ-snzae. -e*) Chronicinf6ctron;as.TB, .

?' Viral infEotibn,,a5 rnqrnps. ,. rreatment.tre":;*.?*::,?*.Bgt*

1.

t ,

Conjunetiviti,s- Clinical Features. Usually bilateral.. Conjunctival hyperaemia.. Grittiness/ sandy sensation.. Digcharge with:,stickJ eye"lids,, Severe cases-,qwol:Ign eye. [{s witli

pseudomenibrane. fur6s11,*.,. IR Gonococcr:s conjuctivitis- swollen eye

lids with eopious'purulent discharge.B}D:&ddrii&nrsDy HPP 36

Acute Dacryocystitis

Elh, hilddii ddffiy;rEFi

Conjunctivitis. Inflarnation of coqiunctiva-. Bacterial: )Strepto. Pyogenes, pneumoniae.

)Staph aureus.)H. Influenzae.)Gbnococcus.

. Viral: Aderrovirus, H. Simplex, H. Zoster .

. Tr?iuma: Chemicals, ulhaiiolet rays,

. Allergic'

qhhthalini'a,neoa*onrm.l ltleonates'ay h &rhi6i qtury, HF t!

-i

syD- a;niihi O,-;r: iPe

Coniunctivitis

Conjunctivitis

Karatitis- inflamation of the corftea' .(corneal ulcer)

r Aetiology:,i" Bac$eria: Staph,; Sffeptci.,,P.seud6monas,Enterobacteriacea2. Fungus: asperyillus, candida albicans3. Viral: H. simplex, H. zoSter4. Acanthamoeba: in contaot lense users.

By B hd:ilSiG!i6!iry, PP

ant ib io i ' i i i ; ,1, ' t ' ' : .. FI. simplex- zorrirrx ointment. Ssdiurn:crsmog-lycafgrdrops with rnild

steroids), atrlereic coniunctivitis.:

Byr. bMifiicnNmx ltPP

Syrnp_tgms & S,igns' Redeye . Conjunctiwalihjec..' Mild..to severe ocular . Focal white infiltiates,:$ifig:''r

- ' ofcoineiltray,ers.A

. P,hotoohobia stromal,ogaema'

. Bluned vision . Severe anlerior

. Eye discharge chamber reaction with:

AYD: &ildfricuNdn BtP 4

. . : /

'Dryeye ' ,. Contact lens We?{. Chronic infections.ofotular a&rexa. Epi.Dbfe

-Traun!;rphemical'futjury etc. Purule conjunetiv is,' Neurolrophic/ Exposure Keratopathy. Topical steroids, sys,irnmunosuppresive. Ttaurna :

- t , . t . . ,

: : t ' : '

Diagnosis

. comeat,sor"ppi l'

'

1 Grarnstain ' -" -

, ,zrK0II .moun ' - ' ' ' . ' t . ' '.

j -.

'Gitlture media: : : i :Bl i

agao' : , ' : , : . . ' , , ' : ' : , : , : :2. Chocolate aear3. Sabouraud's- riietlitim

&D;B.Mdi&ils\., Hpp it

By D. hDndhi tuDy- PP

Basteria.l Kerati,tis; Staph.aureus and Strep-pneumoniae:

-

Produce oval yellow white densely qpaque:s,tlgmal,lbsiOn h:sur.roundng relativelyclear eornea

. Pseudomonas sp. : sharp ulceration withsemiopaque ground glass appearance ofadjacent stroma

. Ehterobactriacea: shallov ulceration withdiffrrse stromal opalescence

. Bacterial Keratitis

Bacterial Keratitis

Bacterla! Keratitis

.Keraffi

By.D. &nin.m tunrD!..Hip

Funga,l Ker.a is.;-

: Co.rneallesiorl.rGr,yi jte,le-sionwithindistinct margin and delicate featheryfi nger Iike projecl-ignsrinto'adjacent strorna

. Multiple satellite small foci

. Overlying epithelium is elevated but intacl

Byb:&ilffiituq,HPP Jl

By D. B.|rmtficwr.my;tlPi

''$o-q [-{-:eF? ,(,eo *. Filamentou". Fbs*i*n-, uspergillus. Non Filzrmentdus- Candidb albicans. Treatrnent. 1.. L er-,pli-ot e'droPs. Z;,fltrcorrazAb-iieA,aq:;Sslution

f: fetacqna"o*,te . '

. 4: Iatroconazole :

. Adti=fungaltt-eutnnent- ti* wdercaYrSmtim.ry.W

'5

Virat,K.-eratit",is:@-,S.[Y9,'r., ,Q6u5sd,[y H;$fi]ilex'v.ilt'is,: :j ''' superficial,pundate ker tis' ,., Dendiitic keratitS(Thin linearrb-mhching

le-rion with'ler,ninal brll'bs'a-t' the end' of eachbranch : r . . . ,

r Geographic utcer- targe:at4oe@ shfped, ulcer with dbnltlirip,eclges;

. gcimeal ggnsii.ivity''6scrtasetl'

. ;Staihed with Rose EengalliSe, l

BYB 8tri$i@nst'UP

viratftoi'atifis"(@,.' Treatment :

l. Topical Acyclovir with cyclqplegic2. Gentle debridement of'theinfipted

,:' epi:as adjlipet,tog,l6i;]lf*i.fire-e.ent!( anti-viral agents continuedfor;seven to

fourteen daysfh'en tapeIed;Wer.one week).;

ayr.Iim*mry,in : 5t

Viral Keratitis (HZV) :i.

tHerpes,Zoster vilrus. :-

Conjunclivits with corneat involvement l(muttiple'micro dendritis with uveitis)' l

. Treatrnent : - orai Acyclovir-

- preservative free artificialtears and lubricant oint'atnight.

t9, :

V:iral guplilis,ftIZV)

10

Viral lGratitis (HZV)

Acantharnoeba Keratitis (cont). Epituliirl and pti epitlrElial.irlfiltiates. Pseg dCndiites,,on,epitlietium ' ,,.. Late si aorn6 strornal,iffiltrates in,the

shape ofa ring.,,.. ,'''.'Nffigusrr.r l-ack"of rpgponse forthe anti.b,iotic and

anti;.firngai therapy : '

i .

n '* : ru*! for-a,"T-, ' , . l "

, , i

Acanthamo$a,Keratitis ( o ont). Treatment, :

,. ) Neoqporin eye.'dropS.l):Brqlprl,el-ol.q.(Propamidineisethionate).i Chtrorhexidine 0i002% eye drops.) Oral,arltri-fhngal therapy:) ftatment:continued for 5-8 weeks aft.er

the resolution"of inflmn. which may takel8 months'in sorne cases.

) Resistant cases- Keratoplastv.ay Dt rymhi tuim9 H'pp ' o!

F.ri.nciples in the managemeltt(corneal ulcer)

' lnmary theraoy. Promotion of re- epithelialisation

--,trr"ubiic-ation.Afi ificjal :tpArs'',';l*idl 6suieiTorso-lf.hap.li , , ,,,-Ban$age,sof i icontabt" l jds. : ' , , ' '

: ryeyqt iqn."qX , , r-

Tiszue adhesivelg,lile:.' Conjunctival .fl4p to cover the tliiniledrout

. cornea. 8Y e. hqdfticoniirq UP 6

l l

A.c antham o eba K eratitis. Extremely pai4ful strornal keratitis usually

in a soft contact lens wearpr who practicespoor CL. hygiene

.,Sg.v-re:ocular:p{iin,,iednesBiaffili',photophobia over apriddof sevp l weeks,

. Early sign- less comeal and anteriorsegment inflammation than would beexpected for the deeree of,oain

-Y

ry.D.r

- , : . '

. . t r ' . :

Prinoiples in the management (cont). Ascorbate-ih severe alkali bums to prornote

healing' Svsr.rron-rspondingcasesneed tlierapeutic

penenejnq_SAerato.plasty. Rasrorffit6tsjntrqit cy:

- Healed corflealulLwith densescarrin g

-penghaliigrfr .erotopl 4t-y. Non responding uldg-s- leadto perferatiotr or

andophthatiritiVpar ophlhalmitis: which needsevisceration

AyD.B.Mfiiotuo] Hp 57

I End,oph,thahlitis. Intraocular inflamation of ocular cavities and

their adjacent structures without extendingbeyond sclera.

tEnAophthd*ir,ifi$+, invoiidentrofls ra anAtclonscapsule::*teddiagiiri .or,oli-t tissues.

Endopfttlralmitis'

G,,4!Iges;1$xo.geaqll.s, &,iEntiogenous. ExogenoE$:'

- Perretr,trting oculaf trauma- Fostop conrplications (cataract & filterlqg

oper-atiqnq). :- CorneAl ulgf,

. Ehdogenoui:-

Septiceinboli-bacterial endocarditis- Sgvereuve(iis: iminunocomp. Patients.

, T.rgplAt u,e.lro{.iorelinitis, -

Spred{ofir$Fftomir

Endophthalmitis. Clinical featuies:

) Ciliary injection.) Exudatioa in AC wf!!ryh.ypop.y9n.) Posteriorsynaohiae.9-. 'Pb,ste.rror:ttv.lfg,i ,-1. :) Vi*eous opaeities/r ctorrifrititis

. Treatment: :

) Vitreal tap for C & S and treat withappropri a!e. anti.bioljcs.

riqu eirnidr,otry, rn. . r

Anterior ljveitis is)

:. Synlplorns:- Pain, unilateral red eye, photophobia and

blurred vision.. Jlgns:

- Circumcorneal congestion- Hazy anterisr ohamber,with eeUs,

-

Severe'inflamatltm)'ihlpopyon-

Keratic precipitateson endotlrelium.- eonstriotei Up;t:*lth,.p"rt.spach,iae.

dy D. eNFaiioudiry. ry n

12

: - -

.A,ntenor Uveitis (Iridocyclitis) (cont)

. Aetiology:)Exogenous- trauma etc.)Endogenous:

- Idiopathic

- Inf- TB, candida, H.Zoster,

Toxoplasmosis, Toxocara- Associated,with systemic diseases asD:M" 4{k}4losinglSp. ondylitls, sar-ogj{o5is.' : . , , . ,

1, : : : . . ' i . '

Anterior Uvejtisi(fui-,al:o lids)1(coat). Investigations:

)ESR, RBS, Blood VDRL, Chest X-Ray,X-Ray Sacroiliac joint.

. Treatment:)Steroids (local & systernic))Mydriatics- to dilate pupil)Specific treatmen-t tb treat the cause

Anterior Uveitis

, Th'Ar-ik Yoti

End Of Presentation

ay B. S|tm6i tuMml. PP'

13