Treatment of eye infections

Description

This is ulceration of the cornea commonly caused by either injuries or infections (Bacterial, Fungal, Viral)

Signs and Symptoms

• Red eye
• Severe pain
• Difficult to open eye in light (photophobia)
• Discharge, water or pus
• Disturbed vision
• Poor vision

Investigations

• Snellen testing - a white spot of the eye may be seen
• On retinoscopy – irregular light refraction Investigation
• Fluorescein staining of the cornea - the wound stains green
• Corneal swab for microscopy, culture and sensitivity

Treatment

• For all types of ulcers, prevent ocular pain with Atropine 1% once daily in the affected eye
• Infections: Bacteria corneal ulcers - use Tetracycline 1% eye ointment, or Chloramphenicol 1% eye
ointment 3-4 times a day
• If not resolving within 2 weeks, then refer

Description

Typically, you see main ulcer, with riders, and satellite ulcers around the main one. (This is seen occasionally.
It may not be seen at all)

Treatment

• Povidone Iodine, 2%, four times daily in the affected eye
• Natamycin, 5% eye suspension given hourly for 7 days
• Econazole, 1% suspension for topical use
• Miconazole, 10mg/ml given subconjunctival or intravitreal given as 10microgram per ml
• Amphotericin B 0.05-0.2% can be made from IV injection and instil every 5 minutes during the first hour and 30 - 60minutes until clinical picture changes.  (protect from light- use umber coloured bottle

Description

Typical characteristic - on Fluorescein 1% or 2% staining a dendritic corneal ulcer (branching)

Treatment

• Acyclovir eye ointment (suspension) five times daily in the affected eye for about 21 days.
Note: If this has a very high association with HIV/AIDS, steroids are contraindicated

Description

Presents 2 – 4 days postpartum in the neonate

Signs and Symptoms

• Hyperacute conjunctivitis with pus, with or without a membrane
• Severe swelling of both eyes

Treatment

• Penicillin G 50,0000 IU in 2 divided closes for 7 days– Systemic
• Penicillin eye drops 1 hourly both eyes

Description

Penetrating wounds are injuries of the eyeball that result from a sharp object. They typically have a wound of entry and a wound of exit. There may or may not have a retained foreign body.
Perforating wounds are injuries of the eyeball that have only one wound of entry, there also may have a retained foreign body.

Signs and Symptoms

• History injury present
• Red eye
• Painful eye
• Soft eye
• The eye may be shrunken due to loss of volume
• There may be subconjunctival haemorrhage.
• Pigment discolouration of the conjunctiva in the area of the wound
• Foreign Body may be seen

Investigations

• X-ray orbit – to rule out intraocular foreign body.
• Ocular ultrasound
• Cranial CT scan

Treatment

• Tetanus toxoid
• I.V antibiotic preferably Cefotaxime 1g Stat Or
• Gentamycin 80m IV Stat
• Refer to the nearest eye unit promptly

Description

This is a bacterial infection of the conjunctiva. Conjunctivitis presents as the red eye without pain.

Signs and Symptoms

• Ocular discomfort – gritty sensation in the eye
• Eye discharge (pus)
• Diffuse conjunctival redness
• Red conjunctiva with discharge
• Normal vision (clear cornea)

Investigations

Fluorescein staining is negative

Treatment

• Tetracycline 1% eye ointment 3 – 6 times daily
• Supportive - Good personal hygiene to prevent re-infection Facial washing

Description

This is a viral infection of the conjunctiva and is associated with bleeding. The condition is very infectious and
difficult to treat. It is often seen in families and epidemics

Signs and Symptoms

• Pain
• Watery discharge
• Ocular discomfort
• Photophobia
• Sub conjunctiva haemorrhage (severe redness).
• Tender cervical lymph nodes, preauricular, submental groups
• Swollen conjunctiva
• Water discharge
• Normal vision

Treatment

• Tetracycline 1% eye ointment 3 times daily for 7 days
• Supportive: Patient hygiene – do not share face cloth Wash face and eyes

Complications

Secondary bacterial infection

Description

It is an inflammation of the eye caused by a chemical substance such as car battery acid, Snake venom, fluid from plants, Household cleaning chemicals. Alkali chemicals are more damaging to the eye than acids

Signs and Symptoms

• Pain
• Redness
• Watering, Pus discharge if secondarily infected

Investigations

Fluorescein staining will reveal the area of conjunctival corneal chemical erosion

Treatment

Emergency management
• Apply local anaesthetic – lignocaine 2% eye drops
• Wash the eye copiously with normal saline or tap water for about 30 minutes
Pharmacological
• Hydrocortisone 1% Eye Ointment. Apply 3-4 times daily
• Atropine eye drops 1% 2 times a day
• Tetracycline 1% eye ointment three times daily if infected
Other Medicines Used in Chemical Burns
• Vitamin C (Sodium ascorbate) 10% drops and a daily oral dose of ascorbic acid 1gm (assist in laying down
of the corneal collagen)
• Collagenase inhibitors: L-cysteine and or Cenicillamine applied topically helpful in preventing corneal
perforation
• Artificial tears: Prevents the effects of corneal drought. SNO tears, or Hypromellose 0.3%
• Bandage soft contact lenses prevent the formation of adhesions between eyelid and eyeball
• Sodium EDTA - Chelates calcium, a cofactor for the collagenase enzyme, thereby rendering the enzyme
unavailable for corneal melting.
Late Treatment
• Division of adhesions between conjunctiva of the eye and eyelid.
• Place an eye shell between the divided bands during ball synechiealisis
• Conjunctiva grafting
• Eyelid surgery to correct the deformity
• Corneal grating after 6 - 12 months to allow for maximum resolution

Description

Allergic inflammation of the conjunctiva. This condition is common but very difficult to treat. A positive family history of the atopic disease may be present

Signs and Symptoms

• Itchy eyes
• Ring of pale, fleshy, pink-grey tissue around the cornea
• Follicles on the tarsal conjunctiva (cobblestone type)

Treatment

• Hydrocortisone 1% eye drops 3-4 times a day
• Sodium Cromoglicate 2% eye drops 5 times daily