Ch 35. Infections of the eyelid.

Question 1

What type of pathogen is related to human byte injuries?

Answer 1

Anaerobic Bacteria

_{i.e: peptococcus, peptostreptococcus, Bacteroides.}

Question 2

What clinical appearance does an anaerobic infection have?

Answer 2

Highly suppurative and fetid, with subcutaneous emphysema.

Question 3

Main agents causing orbital cellulitis in children?

Answer 3

Since the main cause is upper tract infections, the main agents in children are S. Pneumoniae and Haemophilus influenza.

Question 4

Management of preseptal celulitis in children?

Answer 4

Hospital admision for IV ATBs.

H. Influenza and S. Pneumoniae infections are systemic diseases, with rapid progression from pre-septal to orbital and meningitis.

• _{empirical treatment is started with <strong>cefuroxime 7-10 days,</strong> due to its high activity against H.Influenzae, including beta-lactamase-producing strains. They also penetrate blood-brain barrier.} *
• _{Therapy is then continued with oral amox-clav 7-10 days.} *

Question 5

Management of facial erysipela?

Answer 5

(Treatment directed to S. Pyogenes)

IV Penicilin or vancomycin for 48 to 72 hours until clinical improvement, and then continued with oral ATBs for 7-10 days.

Question 6

What pathogens are related to impetigo contagiousum?

Answer 6

Bullous impetigo: S.Aureus

Non-Bullous: S. Aureus and Group A Streptococci.

Question 7

Treatment for impetigo contagiosa?

Answer 7

• Higiene with medical soap followed by bacitracin or erythromycin ointment.
• Oral ATB is preferred to include coverage for staph, and not only for strep, i.e: erythromycin.

Question 8

In an ophthalmological setting, how is the diagnosis of infection by mycobacterium leprae made?

Answer 8

Hansen’s disease must be suspected so that skin of peripheral nerve biopsy can be ordered.

Tuberculoid form: Corneal anesthesia, facial muscle paralysis ie: orbicularis muscle dysfunction, and lagophthalmos.

Lepromatous form: Skin thickening (Brow, supraorbital ridge, eyelid), Madarosis, tylosis, brow hair loss.

Question 9

To which form of infection is actinomyces Israeli mostly associated?

Answer 9

Chronic canaliculitis

Question 10

How can the dx of onchocerciasis de suspected?

tx?

Answer 10

Corneal or anterior chamber acute and severe inflammation in a patient with a history of painless nodules that are palpable over bony prominences of extremities and scalp.

The microfilariae can sometimes be seen in the anterior chamber.

Definitive Dx is made by biopsy of one of the nodules, where the adult nematode can be found.

Tx is with ivermectin