BACTERIAL INFECTIONS OF
EYE
Dr. Ajit Kulkarni
Introduction
Bacterial infections of the eye can affect any part of
the eye, including the eyelid, conjunctiva, cornea,
or external parts.
Some common bacterial eye infections include:
• Conjunctivitis
• Stye
• Bacterial keratitis
• Uveitis
Conjunctivitis
• Often referred to casually as “pink eye”.
• Conjunctivitis is the swelling or inflammation of the conjunctiva, the thin,
transparent layer of tissue that lines the inner surface of the eyelid and
covers the white part of the eye.
Symptoms can include:
• Redness: The white of the eye may appear pink or red due to visible blood
vessels.
• Discharge: Eye discharge may be clear, yellow, white, or green, and can
form a
• crust at night.
• Swelling: The eyelids or the thin layer lining the white of the eye may
swell.
• Itchiness: The eyes may feel itchy, irritated, or burning.
• Tearing: The eyes may water or tear excessively.
• Sensitivity to light: The eyes may be sensitive to light, also known as
photophobia.
• Other symptoms: blurred vision, a gritty feeling, or feeling like something
is in the eye.
Conjunctivitis
Etiology:
• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus species
• Moraxella catarrhalis
• Chlamydia trachomatis
• Gonococcus
• Corynebacteria
Pathophysiology
• Conjunctivitis occurs when the conjunctiva becomes inflamed due to an
infection or an irritant.
• As a result of this inflammation, the blood vessels in the conjunctiva
dilate, causing redness or hyperemia, and the conjunctiva can also become
swollen.
• The inflammation affects the entire conjunctiva, and depending on the
cause, discharge may also be present.
• Bacterial conjunctivitis occurs when the eye's surface tissues are colonized
by normal flora like Staphylococci sp., Streptococci, and Corynebacteria.
• The epithelial covering of the conjunctiva is the primary defense
mechanism against infection, and any disruption in this barrier can lead to
infection.
• Secondary defense mechanisms include immune reactions carried out by
the tear film immunoglobulins and lysozyme, conjunctival vasculature,
and the rinsing action of blinking and lacrimation.
• Treatment
• Cold or warm compresses
• Medicines- antihistamines and mast cell stabilizers.
• Decongestants, steroids and anti-inflammatory drops.
• Diagnosis
• Recent history
• Eye examination
• Sample for culture and sensitivity
Conjunctivitis
Conjunctivitis
Conjunctivitis - Ophthalmia neonatorum
Stye
• A stye, also known as a hordeolum, is a tender, red bump /lump
on the edge of the eyelid that's caused by an infection in an eyelid
gland.
Risk factors include:
• Long-term blepharitis, an inflammation of the eyelid
• Skin conditions like dermatitis
• Medical conditions like diabetes
• Using old cosmetic products
• Not removing eye makeup before bed
• Not disinfecting contact lenses before putting them in
• Changing contact lenses without washing your hands
• Inadequate nutrition
• Sleep deprivation
Stye
Symptoms
• A red bump/lump on your eyelid that is similar to a boil or a
pimple.
• Eyelid pain.
• Eyelid swelling.
• Tearing- watery eyes
• Sensation: A gritty, scratchy feeling, as if there's something in
your eye
• Sensitivity: Light sensitivity
• Crusting: The eye may crust over
• Baeterial Etiology:
• Staph aureus
Stye
Pathophysiology
Due to etiological factors
Inflammation or infection of the eyelash
follicle.
Leads to clogs the duct, the oil can't
drain and backs up into the glands.
The gland becomes swollen and
inflamed
Stye
• Treatment:
• Warm compresses
• Wash your face
• Wash your face daily, including the eye area, with a gentle soap
like baby shampoo.
• Don't touch it- Avoid rubbing or squeezing the stye, as this can
cause the infection to spread.
• Don't wear makeup -Avoid wearing makeup until the infection
heals.
• Take painkillers- To relieve pain, you can take painkillers such
as paracetamol or ibuprofen.
• Antibiotics
• Surgery
• Diagnosis – by clinical observation
Stye
Karatitis
• Keratitis is inflammation of the cornea, the clear, dome-shaped tissue on
the front of your eye that covers the pupil and iris.
Symptoms include:
• Pain
• Impaired eyesight
• Red eye
• Photophobia
• A "gritty" sensation
• Discharge
• Watery eyes
• Itching
Bacterial Keratitis
• Staph. aureus and Strep. pneumoniae:
Produce oval yellow white densely opaque stromal lesion with
surrounding relatively clear cornea
• Pseudomonas sp. : sharp ulceration with semiopaque ground glass
appearance of adjacent stroma
• Enterobacteriaceae: shallow ulceration with diffuse stromal
opalescence
Predisposing Factors
• Dry eye
• Contact lenses
• Eye injury
• Chronic infections of ocular adnexa
• Weakened immune system
• Purulent conjunctivitis
• Topical steroids, systemic immunosuppresive
• Trauma
Pathophysiology
• Corneal invasion by highly virulent bacteria
• Body’s immune response is low
• It sloughs the whole cornea leaving a narrow rim behind
• Total iris prolapse, result in iritis
• Exudate block the pupil and iris, resulting in the formation of a false cornea.
• When these exudates organize and form a thin fibrous layer of the conjunctival
and corneal epithelium, it results in the formation of pseudocornea.
• The formed pseudocornea is very thin and cannot withstand the raised
intraocular pressure, which results in bulging forward of the cornea and the
plastered iris tissue.
• As a result, an ecstatic cicatrix (bulging of a thinned, scarred cornea) forms
called anterior staphyloma (It can be partial or total, depending on the extent of
involvement).
Treatment:
• Some drugs that may be used to treat bacterial keratitis include:
Ciprofloxacin, Ofloxacin, Moxifloxacin, Gatifloxacin, Fortified
cefazolin Vancomycin, Fluoroquinolones, Tobramycin, Gentamicin,
and Topical linezolid
Diagnosis:
• Corneal Scrapping for
1. Gramstain
2. KOH-mount
• Culture media
1. Blood agar
2. Chocolate agar
3. Sabouraud’s medium
Bacterial Keratitis
Bacterial Keratitis
Bacterial Keratitis
Bacterial Keratitis
Uveitis
• Uveitis is a type of eye inflammation that affects the uvea, the middle layer of
tissue in the eye wall.
• The uvea includes the iris, ciliary body, and choroid, which are pigmented
vascular structures.
Symptoms of uveitis can include:
• Eye pain: May be worse when reading
• Red or watery eyes
• Blurred or decreased vision
• Sensitivity to light
• Dark spots or squiggly lines floating across your vision: Also called floaters
• Lights in the corner of your eyes
Uveitis
• Classification:
• There are four types of uveitis, each affecting a different part of the eye:
• Anterior uveitis
• Also called iritis or iridocyclitis, this is the most common type and occurs in
young to middle-aged people. It affects the iris and ciliary body.
• Intermediate uveitis
• Also called cyclitis or vitritis, this type affects the vitreous, the gel in the
middle of the eye. It mostly occurs in children, teenagers, and young adults.
• Posterior uveitis
• The least common type, this affects the choroid and retina at the back of the
eye.
• Panuveitis
• Affects all three major parts of the eye
Uveitis
• Etiology:
• Bacterial uveitis can be caused by a variety of organisms, but most often by –
• Gram positive bacteria like
• Staphylococcus aureus
• Streptococcal organisms - Group B Streptococcus, Streptococcus pneumoniae
• Propionibacterium acnes
• Listeria monocytogenes
Uveitis
Pathophysiology:
• Hematogenous (blood circulation) dissemination of pathogen to eye via
activated macrophages.
• Activated macrophages cross blood-eye barriers
• Introduce the microbes into the eyes (also called the Trojan Horse mechanism,
according to Greek mythology)
• Elicited a systemic immune response and activated a variety of cells of the
adaptive immune system, like B and especially T cells.
• When lymphocytes are activated, they are allowed to cross all blood barriers.
Uveitis
Pathophysiology:
• Once they have found the bacterial antigens presented on HLA molecules of
the previously invaded macrophages, or infected ocular cells, they get
reactivated.
• Reactivated cells subsequently secrete chemokines and cytokines to recruit
further inflammatory cells to ocular tissues.
• Which then induce a deleterious inflammation of the inner eye, impairing or
even destroying the blood-eye barriers.
Treatment:
• Eye drops: Prescription eye drops are the most common treatment
• Pills: steroids and antibiotics
• Injections: Your doctor may inject the steroid into or around your eye with a
small needle.
Uveitis
Diagnosis:
• A thorough eye exam is required to diagnose uveitis, an autoimmune or
inflammatory disorder that can affect the eye:
• Slit-lamp exam
A microscope shines a light through the front of the eye to look for
inflammation
• Tonometry
Measures the pressure inside the eye, also known as intraocular pressure (IOP)
• Dilated eye exam
Eye drops widen the pupil so the doctor can examine the retina and optic
nerves for inflammation with an ophthalmoscope
• Blood tests
• Imaging tests, such as a chest X-ray, CAT scan, or MRI scan
Anterior Uveitis
Anterior Uveitis
Thank You
