Skip to main content
SpringerLink
Log in

Common Ocular Infections

A Prescriber’s Guide

  • Disease Management
  • Published:
Drugs Aims and scope Submit manuscript

Summary

While most ocular infections are benign, others can be associated with devas tating visual consequences. Most patients present with either ocular discharge, visual symptoms or a red or painful eye. The primary care physician is usually the first to evaluate these patients.

We have separated ocular infections into 3 groups. Infections affecting the cornea and conjunctiva often present with eye pain and a red eye; noninfectious aetiologies can have a similar presentation. Infections inside the eye (endophthalmitis) often have devastating consequences. They usually occur following penetrating ocular trauma or after intraocular surgery. Prompt referral to an ophthalmologist is crucial. Infections in the soft tissue surrounding the eye (ocular adnexa and orbit) can involve the eye indirectly and can spread from the orbit into the brain.

The purpose of this article is to review ocular infections and current opinion regarding treatment. A general guideline should be that the approach to treatment be governed by the severity of symptoms and the magnitude of possible consequences. Mild external infections can be typically treated empirically. Severe conjunctivitis, and any corneal infection, require aggressive management, often including cultures and broad spectrum antibiotics; cultures are often used to guide treatment. Devastating vision loss can occur, even with aggressive management. Preseptal cellulitis in adults and older children can be managed conservatively with oral antibiotics if the orbit and optic nerve are not involved and the patient is otherwise healthy. Orbital or optic nerve involvement, on the other hand, demands orbital imaging and more aggressive intervention. Patients who have had recent surgery are at risk for developing endophthalmitis. Complaints of pain or a red eye must be taken very seriously. These patients must be considered to have an intraocular infection until it can be ruled out, and should be aggressively managed by a physician trained in eye diseases and surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wiley L, Springer D, Kowalski RP, et al. Rapid diagnostic testing for ocular adenovirus. Ophthalmology 1988; 95: 431–3

    PubMed  CAS  Google Scholar 

  2. Kinchington PR, Turse SE, Kowalski PP, et al. Use of polymerase chain amplification for the detection of adenoviruses in ocular swab specimens. Invest Ophthalmol Vis Sci 1994; 35: 4126–34

    PubMed  CAS  Google Scholar 

  3. Ward JB, Siojo LG, Waller SG. A prospective, masked clinical trial of trifluridine, dexamethasone, and artificial tears in the treatment of epidemic keratoconjunctivitis. Cornea 1993; 12(3): 216–21

    Article  PubMed  CAS  Google Scholar 

  4. Gordon YJ, Romanowski EG, Araullo-Cruz T. Topical HPMPC is the first effective broad-spectrum antiviral to inhibit both HSV-1 and adenovirus in the NZ rabbit eye models [abstract]. Invest Ophthalmol Vis Sci Suppl. 1993; 34(4): 1346

    Google Scholar 

  5. Romanowski E, Roba LA, Wiley L, et al. The effect of topical corticosteroids on AD5 shedding in the NZ rabbit ocular model [abstract]. Invest Ophthalmol Vis Sci 1994; 35: 1336

    Google Scholar 

  6. Nauheim RC, Romanowski EG, Cruz TA, et al. Prolonged recoverability of desiccated adenovirus type 19 from various surfaces. Ophthalmology 1990; 97: 1450–3

    PubMed  CAS  Google Scholar 

  7. Roba LA, Kowalski RP, Romanowski E, et al. How long are patients with epidemic keratoconjunctivitis infectious? [abstract]. Invest Ophthalmol Vis Sci Suppl. 1993; 24: 848

    Google Scholar 

  8. Robinson MR, Udell IJ, Garber PF, et al. Molluscum contagiosum of the eyelids in patients with acquired immune deficiency syndrome. Ophthalmology 1992; 99: 1745–7

    PubMed  CAS  Google Scholar 

  9. Ullman S, Roussel TJ, Culbertson WW, et al. Neisseria gonorrhea conjunctivitis. Ophthalmology 1987; 94: 525–31

    PubMed  CAS  Google Scholar 

  10. Haimovici R, Roussel TJ. Treatment of gonococcal conjunctivitis with single intramuscular ceftriaxone. Am J Ophthalmol 1989; 107: 511–14

    PubMed  CAS  Google Scholar 

  11. Kowalski RP, Harwick JC. Incidence of moraxella conjunctival infection. Am J Ophthalmol 1986; 101: 437–40

    PubMed  CAS  Google Scholar 

  12. Snyder ME, Katz HR. Ciprofloxacin-resistant bacterial keratitis. Am J Ophthalmol 1992; 114(3): 336–8

    PubMed  CAS  Google Scholar 

  13. Maffett M, O’Day DM. Ciprofloxacin-resistant bacterial keratitis. Am J Ophthalmol 1993; 115(4): 545–6

    PubMed  CAS  Google Scholar 

  14. Rossetti SB, Malbran E, D’Alessandrol L. Fluoroquinolone resistance among ocular bacteria [abstract]. Invest Ophthalmol Vis Sci Suppl. 1995; 36(4): 153

    Google Scholar 

  15. Kowalski RP, Uhrin M, Karenchak LM, et al. The evaluation of the Amplicor™ test for the detection of chlamydial DNA in adult chlamydial conjunctivitis. Ophthalmology 1995; 102; 1016–9

    PubMed  CAS  Google Scholar 

  16. Schachter J. Chlamydiae. Ann Rev Microbiol 1980; 34: 285–309

    Article  CAS  Google Scholar 

  17. Fivush B, Woodward CL, Wald ER. Gonococcal conjunctivitis in a four-month-old infant. Sex Transm Dis 1980; 7: 24–5

    Article  PubMed  CAS  Google Scholar 

  18. Thylefors B, Dawson CR, Jones BR, et al. A simple system for the assessment of trachoma and its complications. Bull World Health Organ 1987; 65: 447–83

    Google Scholar 

  19. Schein OD, Glynn RJ, Poggio EC, et al. The relative risk of ulcerative keratitis among users of daily-wear and extendedwear soft contact lenses. N Engl J Med 1989; 321: 773–8

    Article  PubMed  CAS  Google Scholar 

  20. Poggio EC, Glynn RJ, Schein OD, et al. The incidence of ulcerative keratitis among users of daily-wear and extendedwear soft contact lenses. N Engl J Med 1989; 321: 779–83

    Article  PubMed  CAS  Google Scholar 

  21. Abbott RL, Abrams MA. Bacterial corneal ulcers. In: Tasman W, editor. Duane’s clinical ophthalmology. Vol. 4. Chap. 18. Philadelphia: Lippincott-Raven, 1995: 28

    Google Scholar 

  22. Parks DJ, Abrams DA, Sarfarazi FA, et al. Comparison of topical ciprofloxacin to conventional antibiotic therapy in the treatment of ulcerative keratitis. Am J Opthalmol 1993; 115(4): 471–7

    CAS  Google Scholar 

  23. Wilhelmus KR, Hyndiuk RA, Caldwell DR, et al. 0.3% ciprofloxacin ophthalmic ointment in the treatment of bacterial keratitis. The Ciprofloxacin Ointment/Bacterial Keratitis Study Group. Arch Ophthalmol 1993; 111(9): 1210–8

    Article  PubMed  CAS  Google Scholar 

  24. Kestelyn P, Bogaerts J, Stevens AM, et al. Treatment of adult gonococcal keratoconjunctivitis with oral norfloxacin. Am J Ophthalmol 1989; 108(5): 516–23

    PubMed  CAS  Google Scholar 

  25. Roat MI, Romanowski E, Araullo-Cruz T, et al. The antiviral effects of rose bengal and fluorescein. Arch Ophthalmol 1987; 105: 1415–7

    Article  PubMed  CAS  Google Scholar 

  26. Power WJ, Benedict-Smith A, Hillery M, et al. Randomised double-blind trial of bromovinyldeoxyuridine (BVDU) and trifluorothymidine (TFT) in dendritic corneal ulceration. Br J Ophthalmol 1991; 75(11): 649–51

    Article  PubMed  CAS  Google Scholar 

  27. Nauheim RC, Brockman RJ, Stopak SS, et al. Survival of Acanthamoeba in contact lens rinse solutions. Cornea 1990; 94: 290–3

    Google Scholar 

  28. Berger ST, Mondino BJ, Hoft RH, et al. Successful medical management of Acanthamoeba keratitis. Am J Ophthalmol 1990; 110: 395–403

    PubMed  CAS  Google Scholar 

  29. Larkin DFP, Kilvington S, Dart JKT. Treatment of acanthamoeba keratitis with polyhexamethelene biguanide. Ophthalmology 1992; 99: 185–91

    PubMed  CAS  Google Scholar 

  30. Varga JH, Wolf TC, Jensen HG, et al. Combined treatment of Acanthamoeba keratitis with propamidine, neomycin, and polyhexamethylene biguanide. Am J Ophthalmol 1993; 115: 466–470

    PubMed  CAS  Google Scholar 

  31. Ficker LA, Kirkness C, Wright P. Prognosis for keratoplasty in Acanthamoeba keratitis. Ophthalmology 1993; 100: 105–10

    PubMed  CAS  Google Scholar 

  32. O’Day DM, Head WS, Robinson RD, et al. Anomalous effect of subconjunctival miconazole on Candida albicans keratitis in rabbits. Am J Ophthalmol 1991; 112: 562–6

    PubMed  Google Scholar 

  33. Jones DB, Steinkuller PG. Microbial preseptal and orbital cellulitis. In: Tasman W, editor. Duane’s clinical ophthalmology. Vol. 4. Chap. 25. Philadelphia: Lippincott-Raven, 1995

    Google Scholar 

  34. Shapiro ED, Wald ER, Bronzanski BA. Periorbital cellulitis and paranasal sinusitis: a reappraisal. Pediatr Infect Dis J 1982; 1: 91–4

    Article  CAS  Google Scholar 

  35. Barson WJ, Miller MA, Marcon MJ, et al. Cefuroxime therapy for bacteremic soft-tissue infections in children. Am J Dis Child 1985; 139: 1141–4

    PubMed  CAS  Google Scholar 

  36. Baker RC, Bausher JC. Meningitis complicating acute bacteremic facial cellulitis. Pediatr Infect Dis J 1986; 5: 421–3

    Article  CAS  Google Scholar 

  37. Shapiro ED, Murphy TV, Wald ER, et al. The protective efficacy of Haemophilus-β polysaccharide vaccine. JAMA 1988; 260: 1419–22

    Article  PubMed  CAS  Google Scholar 

  38. Gonzalez Valdepena H, Wald ER, Rose E et al. Epiglottis and Haemophilus influenzae immunization: the Pittsburgh experience — a five-year review. Pediatrics 1995; 96: 424–7

    PubMed  CAS  Google Scholar 

  39. Dagan R, Phillip M, Watemberg NM, et al. Outpatient treatment of serious community-acquired pediatric infections during once daily intramuscular ceftriaxone. Pediatr Infect Dis J 1987; 6: 1080–4

    PubMed  CAS  Google Scholar 

  40. Einhorn M, Fliss DM, Leiberman A, et al. Otolaryngology and infectious disease team approach for outpatient management of serious pediatric infections requiring parenteral antibiotic therapy. Int J Pediatr Otorhinolaryngol 1992; 24: 245–51

    Article  PubMed  CAS  Google Scholar 

  41. Brady MT, Barson WJ, Cannon Jr JH, et al. Onset of Haemophilus influenzae type-b meningitis during cefaclor therapy for preseptal cellulitis. Clin Pediatr 1987; 26: 132–4

    Article  CAS  Google Scholar 

  42. Shields JA, Shields CL, Suvarnamani C, et al. Retinoblastoma manifesting as orbital cellulitis. Am J Ophthalmol 1991; 112: 442–9

    PubMed  CAS  Google Scholar 

  43. Harris GJ. Subperiosteal abscess of the orbit. Age as a factor in the bacteriology and response to treatment. Ophthalmology 1991; 101: 585–95

    Google Scholar 

  44. Noel LP, Clarke WN, MacDonald N. Clinical management of orbital cellulitis in children. Can J Ophthalmol 1990; 25: 11–6

    PubMed  CAS  Google Scholar 

  45. Ciarallo LR, Rowe PC. Lumbar puncture in children with periorbital and orbital cellulitis. J Pediatr 1993; 122: 355–9

    Article  PubMed  CAS  Google Scholar 

  46. Singh B. The management of sinogenic orbital complications. J Laryngol Otol 1995; 109: 300–3

    PubMed  CAS  Google Scholar 

  47. Rubin SE, Rubin LG, Zito J, et al. Medical management of orbital subperiosteal abscess in children. J Pediatr Ophthalmol Strabismus 1989; 26: 21–7

    PubMed  CAS  Google Scholar 

  48. Puliafito CA, Baker AS, Haaf J, et al. Infectious endophthalmitis. Ophthalmology 1982; 89: 921–9

    PubMed  CAS  Google Scholar 

  49. Speaker MG, Milch FA, Shah MK, et al. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 1991; 98: 639–50

    PubMed  CAS  Google Scholar 

  50. Miester DM, Mandelbaum S. Propionibactium-associated endophthalmitis after extracapsular cataract extraction: review of reported cases. Ophthalmology 1989; 96: 54–61

    Google Scholar 

  51. Boldt HC, Pulido JA, Blodi CF, et al. Rural endophthalmitis. Ophthalmology 1989; 96: 1722–6

    PubMed  CAS  Google Scholar 

  52. Uliss AE and Walsh JR. Candida endophthalmitis. Ophthalmology 1983; 90: 1378–9

    PubMed  CAS  Google Scholar 

  53. Griffin JR, Pettit TH, Fishman LS, et al. Blood borne Candida endophthalmitis. Arch Ophthalmol 1973; 89: 450–6

    Article  PubMed  CAS  Google Scholar 

  54. Aguilar GL, Blumenkrantz MS, Egbert PR, et al. Candida endophthalmitis after intravenous drug abuse. Arch Ophthalmol 1979; 97: 96–100

    Article  PubMed  CAS  Google Scholar 

  55. Donahue SP, Eller AW. Intraocular Candida infection. Semin Ophthalmol 1993; 8: 70–6

    Article  Google Scholar 

  56. Walsh A, Haft DA, Miller MH, et al. Ocular penetration of 5-fluorocytosine. Invest Ophthalmol Vis Sci 1978; 17: 691–4

    PubMed  CAS  Google Scholar 

  57. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. Arch Ophthalmol 1995; 113: 1479–96

    Article  Google Scholar 

  58. Forster RK. Management of infectious endophthalmitis. Ophthalmology 1980; 87: 313–9

    PubMed  CAS  Google Scholar 

  59. Zanbrao W, Flynn HW, Plugfelder SC, et al. Management options for P. acnes endophthalmitis. Ophthalmology 1989; 96: 1100–5

    Google Scholar 

  60. Winward KE, Plugfelder SC, Flynn HW, et al. Postoperative Propionibacterium endophthalmitis. Ophthalmology 1993; 100: 447–51

    PubMed  CAS  Google Scholar 

  61. Doft BH, Barza M. Ceftazidine or Amikacin. Choice of in-travitreal antimicrobials in the treatment of postoperative en-dophthlamitis. Arch Ophthalmol 1994; 112: 17–8

    Article  PubMed  CAS  Google Scholar 

  62. Campochiaro PA, Lim JI. Aminoglycoside toxicity in the treatment of endophthalmitis. Arch Ophthalmol 1994; 112: 48–53

    Article  PubMed  CAS  Google Scholar 

  63. Conway BP, Campochiaro PA. Macular infarction after endophthalmitis treated with vitrectomy and intravitreal gentamicin. Arch Ophthalmol 1986; 104: 367–71

    Article  PubMed  CAS  Google Scholar 

  64. Donahue SP, Kowalski RP, Eller AW, et al. Empiric treatment of endophthalmitis: are aminoglycosides necessary? Arch Ophthalmol 1994; 112: 45–7

    Article  PubMed  CAS  Google Scholar 

  65. Aaberg TM, Flynn HW, Murray TG. Intraocular ceftazidime as an alternative to the aminoglycosides in the treatment of endophthalmitis. Arch Ophthalmol 1994; 112: 18–19

    Article  PubMed  Google Scholar 

  66. Forster RK. Endophthalmitis. In: Tasman W, editor. Duane’s clinical ophthalmology. Vol. 4. Chap. 24. Philadelphia: Lippincott-Raven, 1995: 15

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

    Sean P. Donahue & Johnny M. Khoury

  2. Campbell Laboratory for Ophthalmic Microbiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Regis P. Kozvalski

Authors
  1. Sean P. Donahue
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johnny M. Khoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Regis P. Kozvalski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean P. Donahue.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Donahue, S.P., Khoury, J.M. & Kozvalski, R.P. Common Ocular Infections. Drugs 52, 526–540 (1996). https://doi.org/10.2165/00003495-199652040-00006

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199652040-00006

Keywords

Search

Navigation