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Infections of the Eye


Jonathan Bland
Pathophysiology
Professor Lori McGowan

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Etiology

Stye
Stye (hordeola) is an acute
bacterial process that
causes localized abscess
formation of the eyelid
involving 1 of 3 glands.
Staphylococcus aureus
and S. epidermis are the
most common organisms
associated with a
hordeolum. This process
occurs more commonly in
adults than in children,
possibly due to anatomic
differences. Patients with a
chronic illness such as
diabetes, blepharitis,
seborrhea, and high serum
lipids may also be at
increased risk.

Conjunctivitis
Conjunctivitis is one of the
most common non-traumatic
eye complaints resulting in
presentation to the ED. The
term describes any
inflammatory process that
involves the conjunctiva;
however, to most patients,
conjunctivitis (often called
pink eye) is a diagnosis in its
own right. Most causes of
conjunctivitis are benign, and
the role of the emergency
physician is to separate
those few conditions
requiring more vigorous
treatment from the majority
that can be handled
satisfactorily in the ED.

Keratitis
Keratitis is the medical term
for inflammation of the
cornea. The cornea is the
dome-shaped window in the
front of the eye. When looking
at a person's eye, one can
see the iris and pupil through
the normally clear cornea.
The cornea bends light rays
as a result of its curved shape
and accounts for
approximately two-thirds of
the eye's total optical power,
with the lens of the eye
contributing the remaining
one-third. Only the very thin
tear film lies between the front
of the cornea and our
environment.

Chalazion is more often a


chronic process and results
from an inflammatory
foreign body reaction to
sebum. Blockage of normal
drainage of sebaceous
glands, especially at the
eyelid margin, by
blepharitis, acne rosacea,
or hordeolum may
contribute to development
of chalazia. (Epocrates,
2011)

Cellular infiltration and


exudation characterize
conjunctivitis on a cellular
level. Classification usually is
based on cause, including
viral, bacterial, fungal,
parasitic, toxic, chlamydial,
chemical, and allergic
agents. It also can be based
on age of occurrence or
course of disease. Etiology
often can be distinguished
on clinical grounds. In
keratoconjunctivitis, an
associated corneal
involvement is present.
(Silverman, 201)

Bacteria most frequently


responsible for keratitis
include Staphylococci,
Hemophilus, Streptococci,
and Pseudomonas. If the
front surface of the cornea
has been damaged by a small
scratch and the surface is not
intact, almost any bacteria,
including atypical
mycobacteria, can invade the
cornea and result in keratitis.
Ulcerations of the cornea may
occur, a condition known as
ulcerative keratitis. Before the
advent of antibiotics, syphilis
was a frequent cause of
keratitis.
Viruses that infect the cornea
include respiratory viruses,
including the adenoviruses
and others responsible for the

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Running Header: Infections of the Eye

common cold. The herpes


simplex virus is another
common cause of keratitis.
There are about 20,000 new
cases of ocular herpes in the
United States annually, along
with more than 28,000
reactivations of the infection.
There are about 500,000
people in the U.S. with a
history of herpes simplex eye
disease. The herpes zoster
virus (the virus responsible for
chickenpox and shingles)
may also cause keratitis if
shingles involve the forehead.
Fungi such as Candida,
Aspergillus, and Nocardia are
unusual causes of microbial
keratitis, more frequently
occurring in people who are
immunocompromised
because of underlying
illnesses or medications.
Fusarium keratitis, a type of
fungal infection, occurs
primarily in contact-lens
wearers. Bacterial coinfection can complicate
fungal keratitis.
Contact-lens wearers are also
susceptible to acanthamoeba
keratitis caused by an amebic
parasite. "River blindness," or
onchocercal keratitis, is
another parasitic infection of
the cornea, rarely seen in
developed countries but very
common in the Third World.
(Dahl & Stoppler, 2011)

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Symptoms of a sty are


generally redness,
Symptoms tenderness, and pain in the
affected area. The infected
eye may feel irritated or
scratchy. Later signs and
symptoms may include
swelling, discomfort during
blinking of the eye,
yellowish spot at the center
of the bump that
represents pus rising to the
surface.
Treatments Application of a warm
compress or warm
washcloth to the affected
area for 10 minutes, four to
six times a day, can be an
effective home remedy and
speed rupture of the sty
that aids in the relief of
symptoms. A sty should
not be pressed or
squeezed to facilitate
drainage, since this can
spread or worsen the
infection. If a sty persists
for several days, a doctor
may lance (drain) the
infection under local
anesthesia in his or her
office. Children who require
surgical drainage of a sty
may need a general
anesthetic. Antibiotic
ointments and/or steroid
ointments sometimes are
prescribed to treat a sty.
Rarely, systemic (oral)
antibiotics are
recommended for
persistent or multiple stys.
Over-the-counter pain
medications may be used

Redness in the white of the


eye or inner eyelid.
Increased amount of tears.
Thick yellow discharge that
crusts over the eyelashes,
especially after sleep. Green
or white discharge from the
eye. Itchy eyes, burning
eyes, blurred vision, and
increased sensitivity to light.

Include, pain, tearing, and


blurring of vision in the
effected eye. Pain may be
mild to severe, depending on
the cause and extent of the
inflammation. The patient
may have sensitivity to light.
The patients eye may appear
red, watery, and if the cornea
has extensive keratitis, the
normally clear cornea may
look gray or have white to the
gray areas.
Bacteria. Pinkeye caused by Treatment depends on the
bacteria, including STDs, is
cause of the keratitis.
treated with antibiotics, in the Infectious keratitis generally
form of eye drops, ointments, requires antibacterial,
or pills. Eye drops or
antifungal, or antiviral therapy
ointments may need to be
to treat the infection. This
applied to the inside of the
treatment can involve
eyelid three to four times a
prescription eye drops, pills,
day for five to seven days.
or even intravenous therapy.
Pills may need to be taken
Any corneal or conjunctival
for several days. The
foreign body should be
infection should improve
removed. Wetting drops may
within a week. Take the
be used if disturbance of the
medicine as instructed by
tears is suspected to be the
your doctor, even if the
cause of the keratitis. Steroid
symptoms go away.
drops may often be
prescribed to reduce
Viruses. This type of pinkeye inflammation and limit
often results from the viruses scarring. This must be done
carefully and judiciously,
that cause a common cold.
since some infections can be
Just as a cold must run its
worsened with their use.
course, so must this form of
(Dahl & Stoppler, 2011)
pinkeye, which usually lasts
from four to seven days.
Viral conjunctivitis can be
highly contagious. Avoid
contact with others and wash
hands frequently.

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to alleviate pain and


tenderness. Contact lenses
and eye makeup should
never be worn during
treatment for a stye
(MedicineNet.Com, 2011).

Irritants. For pinkeye caused


by an irritating substance,
use water to wash the
substance from the eye for
five minutes. Your eyes
should begin to improve
within four hours after
washing away the
substance. If the
conjunctivitis is caused by
acid or alkaline material such
as bleach, call your doctor.
Allergies. Allergy-associated
conjunctivitis should improve
once the allergy is treated
and the allergen removed.
See your doctor if you have
conjunctivitis that is linked to
an allergy. (WebMD, 2011)

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Works Cited
Dahl, A. M., & Stoppler, M. (2011). Keratitis. Retrieved April 22, 2011, from MedicineNet.Com:
http://www.medicinenet.com/keratitis/article.htm

Epocrates. (2011). Stye and Chalazion. Retrieved April 22, 2011, from Epocrates:
https://online.epocrates.com/u/2924214/Stye+and+chalazion/Basics/Etiology

Gould, B. E. (2006). Pathophysiology for the Health Professionals, 3rd Edition. Philadelphia: W.B.
Sauders.

MedicineNet.Com. (2011). Sty. Retrieved April 22, 2011, from MedicineNet.com:


http://www.medicinenet.com/sty/article.htm

Silverman, M. M. (201, April 27). Conjunctivitis. Retrieved April 22, 2011, from Medscape Reference:
http://emedicine.medscape.com/article/797874-overview#a0101

WebMD. (2011). Conjunctivitis. Retrieved April 22, 2011, from WebMD: http://www.webmd.com/eyehealth/eye-health-conjunctivitis

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