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STAPHYLOCOCCAL BLEPHARITIS
Chronic inflammation of
eyelid margins
Staphylococcus aureus and
Staphylococcus epidermidis
Pathogenesis: cell-mediated
immune response with
hypersensitivity to S. aureus
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LACRIMAL APPARATUS INFECTIONS
DACROADENITIS
Inflammation of the lacrimal gland
Most common cause:
o Nocardia, Actinomyces, anaerobic bacteria, or a mixed
flora of both gram positive and gram negative bacteria
Nocardia Actinomyces
CONJUNCTIVITIS (1)
Benign & often self limiting if not diagnosed and
treated properly ocular morbidity of
devastating consequences
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Conjungtivitis bacterial
Conjungtivitis viral
Conjungtivitis chlamydia
Conjungtivitis chlamydia Conjungtivitis gonorrheoe
Allergic conjungtivitis
BACTERIAL CONJUNCTIVITIS (1)
Types of Bacterial
Conjunctivitis:
Hyperacute Chronic (>4 weeks)
(Ophtalmia neonatorum) o Staphylococcus aureus
o Neisseria gonorrhoeae
o Moraxella lacunata
o Streptococcus
Acute pneumoniae
o Staphylococcus aureus o Haemophilus influenzae
o Streptococcus pneumoniae o Haemophilus aegyptius
o Haemophilus influenzae
BACTERIAL CONJUNCTIVITIS (2)
DIPHTERIC (MEMBRANOUS) CONJUNCTIVITIS
necrosis and sloughing of conjunctival epithelium due to
diffusible toxins produced by the bacterium
Should be differentiated with severe
form of pseudomembranous
conjunctivitis (Streptococcus pyogenes,
Neisseria gonnorhoeae, Haemophilus
influenzae, and rarely Staphylococcus
aureus and Streptococcus pneumoniae)
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BACTERIAL CONJUNCTIVITIS (3)
CHLAMYDIA CONJUNCTIVITIS (1)
Chlamydia trachomatis, a non-motile, Gram negative
intracellular bacterium
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BACTERIAL CONJUNCTIVITIS (5)
CHLAMYDIA CONJUNCTIVITIS (3)
Inclusion conjunctivitis
o serovar D, E, F, G, H, I, J, K, found in genital tract
o have been reported in more than 25% of newborn conjunctivitis
o has a range of clinical features indistinguishable from viral,
baterial and allergic
o conjunctivitis or keratoconjunctivitis and clinical presentation may
be acute or chronic
(a) Normal conjunctiva (b) Follicular trachomatous inflammation (TF). (c) Intense
trachomatous inflammation (TI) (and follicular trachomatous inflammation). (d)
Conjunctival scarring (TS). (e) Trichiasis (TT). (f) Corneal opacity (CO
LABORATORY DIAGNOSIS (1)
Often number of organisms are small
In particular, patients with external eye infection often are
on topical antibiotics when referred to for investigation
Fastidious organisms are frequently encountered, therefore
enriched media are necessary
Inoculation of media are done at `bedside' and use of
transport or preservative media is avoided particularly for
bacterial isolation.
LABORATORY DIAGNOSIS (2)
LID MARGIN
No topical anaesthetic is needed.
Sterile cotton tipped swab in brain heart infusion broth (BHIB) is rubbed
over the lid margin
Swab is inoculated directly
Media:
o Blood Agar (BA)
o Chocolate Agar (CA)
o Brucella Blood Agar (BBA)
Smears to glass slide, and stained with: Gram
LABORATORY DIAGNOSIS (3)
CONJUNCTIVAL SWAB
Swab is inoculated directly
Media:
o Blood Agar (BA)
o Chocolate Agar (CA)
o Brucella Blood Agar (BBA)
Smears to glass slide, and
stained with: Gram, Giemsa, ZN,
immunofluorescent
LABORATORY DIAGNOSIS (4)
CONJUNCTIVAL SWAB
Gram stained smear of conjunctival swab showing the pus cells Growth of Propionibacterium
(polymorpho leucocytes) and typical coryneform diptheriodes in acnes colonies on Brucella Blood
clusters and in singles and pairs agar (anaerob)
LABORATORY DIAGNOSIS (5)
CONJUNCTIVAL SCRAPPING
For detection and isolation of Chlamydia trachomatis and viruses
Topical anaesthetic is placed over the eye
Scrap using the Kimura spatula
Media:
o Blood Agar (BA)
o Chocolate Agar (CA)
o Brucella Blood Agar (BBA)
o Sucrose phosphate broth
o HBSS (for virus)
Smears to glass slide, and stained with: Gram, Giemsa, ZN, immunofluorescent
Mikroskopis Chlamydia
Pemeriksaan dalam gelas objek
diwarnai dengan pewarnaan giemsa atau larutan jodium
diperiksa dengan mikroskop cahaya biasa.
Pada pewarnaan Giemsa, Badan Inklusi (BI) terdapat intra
sitoplasma sel epitel akan nampak warna ungu tua,
sedangkan dengan pewarnaan yodium akan terlihat berwarna
coklat.
Jika dibanding dengan cara kultur, pemeriksaan mikrosopik
langsung ini sensitifitasnya rendah dan tidak dianjurkan pada infeksi
asimtomatik.
Pengecatan Giemsa
The viruses spread rapidly in the community as a result of respiratory tract to eye, eye
to eye and via infected tissues and clothes and other fomites and contaminated
swimming pools.
VIRAL CONJUNCTIVITIS (6)
ADENOVIRAL
CONJUNCTIVITIS
Laboratory diagnosis
o detection of virus by
direct methods and
isolation of the infecting
agent
o isolation by conventional
test tube cell cultures
Report from the Ad Hoc Committee for the Management of Epithelial Herpetic Keratitis. Reviewed by the
Committee November 11, 2012, Chicago, IL
Tzanck smear demonstrating multinucleated giant cells (Giemsa stain,
1000)
VIRAL KERATITIS (2) HZO KERATITIS
Herpes Zoster Ophthalmicus (HZO)
Due to activation of latent varicella zoster virus (VZV)
infection
Dendrites (coarse, stellate, no terminal bulbs), punctate
keratitis, mucous plaques
Resolve w/out treatment w/in 1 mo
LABORATORY DIAGNOSIS (1)
Collection of corneal scrapping (with the aid of slit
lamp)
Topical anaesthetic is applied
Avoid eyelashes contamination
Purulent material is removed
Sterile Kimura spatula is used