0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44
856 Intraocular Infection■Pain, redness, light sensitivity
■Recent ocular trauma (bacillus), ocular surgery (staph epi or P acnes),
or external herpes virus infection (HSV or VZV)
■Immunosuppression, either iatrogenic or secondary to systemic dis-
ease
■Disseminated infection (TB, fungi, bacteria, syphilis)
■Prolonged history of indwelling catheter (candida)Signs & Symptoms
■Redness (ciliary flush), cell & flare, keratic precipitates (type and
distribution), hypopyon
■Increasing (rather than decreasing) postop pain and redness
■Fine white plaque on lens capsule (suggests postop infection with P.
acnes)
■IOP may be elevated with HSV, VZV and toxo
■Inflammatory cells in vitreous
➣“String of pearls” sign suggests fungus
■Retinal inflammation
➣Unifocal – toxoplasmosis and most CMV
➣Multifocal – VZV, HSV, endogenous bacterial or fungal endoph-
thalmitis
➣No view – bacterial endophthalmitis
➣Old retinal scar with adjacent inflammation suggests toxoplas-
mosis.tests
Laboratory
■Specific:
➣Corneal sensation if considering HSV or VZV
➣Serology for HSV, VZV, T. gondii rarely of value
➣PPD, FTA, Lyme and Bartonella serology as dictated by exam
➣Blood cultures for suspected endogenous endophthalmitis
➣Vitreous biopsy for bacterial/fungal culture and PCR (for HSV,
VZV, CMV and T. gondii)
➣Note: aqueous tap may be as sensitive for PCR detection of viral
DNA, but not for PCR detection of T. gondii. Aqueous also rarely of
value in determining local elevated antibody titers (Goldmann-
Witmer coefficent).Imaging
■CXR to rule out systemic TB