PDF Dermatitis: HZV and HSV Infections: Adult Patients Redness of ...
Common Eye Infections: Adult
Patients
Julie D. Meier, MD Assistant Professor of Ophthalmology
OSU Eye and Ear Institute
Dermatitis: HZV and HSV
? Redness of periocular skin can be allergic (if associated with prominent itching) or bacterial (if associated with open sores/wounds)
? Both HZV and HSV can have devastating ocular sequelae if not treated promptly
General Categories of Eye Infections
? Dermatitis of Lids (HZV, HSV) ? Cellulitis of Lids (pre- vs post-septal) ? Blepharitis ? Conjunctivitis ? Keratitis
Herpes Zoster Ophthalmicus
? Symptoms: Skin rash and pain, may be preceded by headache, fever, eye pain or blurred vision
? Signs: Vesicular skin rash involving CN V distribution; Involvement of tip of nose can predict higher rate of ocular involvement
1
Herpes Zoster Ophthalmicus
? Work-up
9 Duration of rash; Immunocompromised?
9 Complete ocular exam, including slit lamp, IOP, and dilated exam
? Can have conjunctival or corneal involvement, elevated IOP, anterior chamber inflammation, scleritis, or even involvement of retina and optic nerve.
Herpes Simplex Virus
? Symptoms: 9 Red eye, pain, light sensitivity, skin rash 9 Fever, flu-like symptoms
? Signs: 9 Skin rash: Clear vesicles on erythematous base that progress to crusting
Herpes Zoster Ophthalmicus
? Treatment:
9 If present within 3 days of rash's appearance: oral Acyclovir/ Valacyclovir
9 Bacitracin ointment to skin lesions 9 Warm compresses
9 TOPICAL ANTIVIRALS (e.g. Viroptic) HAVE NO ROLE
Herpes Simplex Virus
? Work-up:
9 Previous episodes?
9 Previous nasal, oral or genital sores?
9 Recurrences can be triggered by fever, stress, trauma, UV exposure
9 External exam: More suggestive of HSV if lesions centered around eye and no involvement of forehead/scalp
9 Slit Lamp Exam, IOP check, dilated exam
2
Herpes Simplex Virus
? Treatment:
9 Bacitracin ointment to skin lesions
9 Any lid margin, conjunctival, or corneal involvement needs topical antivirals (e.g. Viroptic) and close care with ophthalmologist
Preseptal Cellulitis
? Signs: 9 Eye is quiet, no pain or restriction of eye movement 9 May be a history of recent trauma or chalazion (stye) or recent infection such as dacryocystitis
? Organisms: 9 Usually S. aureus or strep species
Cellulitis Preseptal vs Postseptal
? Orbital septum: membrane separating lids from orbital contents
? Symptoms:
9 Both: Tenderness of lids, swelling, redness
9 Orbital cellulitis: Pain on eye movement, fever, double vision, eye itself is also red, decreased vision
Preseptal Cellulitis
? Work-up: 9 Sinus congestion or discharge? Trauma? 9 Full eye exam, especially checking motility and any evidence of proptosis
? Treatment: 9 If afebrile, Augmentin PO X 10 days 9 Follow every 1-2 days until definite improvement 9 If febrile, or no improvement after a few days, hospitalize for IV antibiotics
3
Orbital Cellulitis
? Signs:
9 Pain on eye movement or restriction, decreased vision, proptosis, eye itself red
? Organisms:
9 Staph and strep species, bacteroides, gram negative rods
9 Mucomycosis must be considered in all diabetic or immunocompromised patients
Blepharitis
? Inflammation of anterior or posterior lid margins
? Symptoms: Itching, burning, crusting
? Signs: Crusts to lashes, mucous discharge, swollen lids, may have corneal infiltrates
Orbital Cellulitis
? Work-up:
9 Trauma, diabetes/immunocompromised, systemic symptoms?
9 Complete eye exam (motility, proptosis, optic nerve abnormality)
9 CT scan of orbits
9 CBC, blood cultures
? Treatment: Hospitalize for IV antibiotics and close follow-up
Blepharitis
? If woman, ask about eye make-up hygiene.
9 Should be throwing away every 3-4 months, removing each night, washing hands before application and not sharing products'
9 Poor make-up related hygiene can lead to blepharitis, conjunctivitis and even corneal infection
9 Products contaminated after first use
4
Blepharitis
? Treatment:
9 Warm compresses for 10-15 minutes twice daily, followed by lid scrubs with baby shampoo
9 Lubrication with artificial tears 3-4 times daily
9 If moderate to severe, can add erythromycin ophthalmic ointment at bedtime
Bacterial conjunctivitis
? Etiology (acute presentation) 9 Gonococcus 9 Staph species 9 Strep pneumonia 9 Hemophilus influenzae (kids)
Bacterial conjunctivitis (acute)
? Signs: 9 Purulent discharge of varying degree 9 Chemosis (swelling of the conjunctiva)
? Symptoms: 9 Redness, foreign body sensation
Gonococcal vs other bacterial agents
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