ABSTRACT
RESUMO Objetivo: Avaliar as características das urgências oftalmológicas atendidas no Pronto Socorro do Instituto de Olhos de Goiânia, com destaque à conjuntivite infecciosa, morbidade de maior incidência neste Serviço. Visa ainda delinear as principais etiologias encontradas dentre as conjuntivites infecciosas e compará-las às encontradas em diversos outros serviços de referência em Oftalmologia, norteando, assim, futuros diagnósticos e tratamentos das patologias infecciosas oculares. Métodos: Estudo transversal e retrospectivo, com 783 pacientes atendidos na emergência oftalmológica do Instituto de Olhos de Goiânia, no período de primeiro de maio a 03 de setembro de 2017. Os dados foram coletados por meio de protocolos baseados nos prontuários físicos da emergência oftalmológica do hospital. Resultados: Observou-se que, quanto às causas diagnósticas, a principal foi a conjuntivite aguda, seguida, em ordem decrescente de incidência, por hordéolo e corpo estranho em superfície ocular, com porcentagens, respectivamente, de 10,98% e 9,96%. Dentre os 783 pacientes admitidos na emergência neste período, 302 foram diagnosticados com conjuntivite, representando uma porcentagem de 38,56% da totalidade dos atendimentos. Dentre essas, 226 foram diagnosticados como sendo de etiologia bacteriana e 38 de etiologia viral. Os números absolutos nos levam a uma porcentagem de 74,8% de conjuntivite bacteriana. Conclusão: A conjuntivite infecciosa representa uma porcentagem substancial dentre as patologias admitidas nos serviços de urgência oftalmológica em todo o mundo. No presente estudo houve ainda prevalência da conjuntivite bacteriana, bem como uma tendência irrefutável à instituição precoce de antibioticoterapia tópica. A alta prevalência desta comorbidade e a dificuldade no diagnóstico clínico da etiologia da infecção reitera a necessidade de realização de maiores estudos na área, a fim de otimizar o diagnóstico e a terapêutica da conjuntivite infecciosa.
ABSTRACT Objective: Evaluate the epidemiology of ocular emergencies in a Reference Ophthalmological Hospital in Goiânia, with emphasis on acute infectious conjunctivitis, morbidity with a higher incidence in this Service. It aims to delineate the main etiologies found among infectious conjunctivitis and to compare them with those found in several others Ophthalmology reference services, thus guiding future diagnoses and treatments of ocular infectious diseases. Methods: A cross-sectional and retrospective study was conducted with 783 patients seen at the ophtalmological emergency of the Goiânia Institute of Eyes from May 1 to September 3, 2017. Data were collected through protocols based on physical charts of the ophthalmologic emergency of the hospital. Results: The most common ocular emergencies were acute conjunctivitis, followed in decreasing order of incidence by hordeolum and foreign body on ocular surface, with percentages, respectively, of 10.98% and 9.96%, respectively. Among the 783 patients admitted to the emergency room in this period, 302 were diagnosed with conjunctivitis, representing a percentage of 38.56% of the total number of visits. Of these, 226 were diagnosed as having bacterial etiology (74.8%) and 38 (25.2%) as viral etiology. Conclusion: Infectious conjunctivitis represents a substantial percentage of the pathologies admitted to ophthalmological emergency services worldwide. In the present study there was also a prevalence of bacterial conjunctivitis, as well as an irrefutable tendency to the early institution of topical antibiotic therapy. The high prevalence of this comorbidity and the difficulty in the clinical diagnosis of the etiology of the infection reiterates the need for further studies in the area in order to optimize the diagnosis and treatment of infectious conjunctivitis.
Subject(s)
Humans , Eye Infections/etiology , Eye Infections/epidemiology , Conjunctivitis/etiology , Conjunctivitis/epidemiology , Eye Infections/diagnosis , Medical Records , Cross-Sectional Studies , Retrospective Studies , Morbidity , Conjunctivitis/diagnosis , Emergency Service, Hospital/statistics & numerical dataABSTRACT
The present study was performed to describe 2 cases of human thelaziasis (HT) which occurred in Gyeongsangnam- do and to briefly review the previously reported Korean cases. A 58-year old woman, residing in Hadong-gun, Gyeongsangnam-do, came to Gyeongsang National University Hospital (GNUH) complaining of foreign body sensation and itching of the right eye in March 2000. Total 6 adult nematodes of Thelazia callipaeda (2 males and 4 females) were detected in her right eye. A 80-year old man, residing in Jinju-si, Gyeongsangnam-do, came to GNUH complaining of foreign body sensation, itching, and pain of the right eye in December 2007. A total of 5 worms (4 females and 1 degenerated) were removed from his right eye. We analyzed characteristics of the total 39 Korean HT cases reported to date, including the present 2 cases. Most of the cases (71.8%) occurred in Seoul and Gyeonggi-do before 2000, and 21 cases (53.8%) were males and 18 (46.2%) were females. The prevalence was higher in younger ages below 30 years (48.7%) than 31-60 years (41.0%) and over 61 years (10.3%). The seasonal prevalence showed a higher incidence in autumn (43.6%) than in other seasons. Most of the cases (94.9%) were conjunctival sac infections and only 2 (5.1%) were intraocular cases. The present 2 HT cases are the first reported cases in Gyeongsangnam-do. Some characteristics of Korean HT cases were analyzed.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Animals , Female , Humans , Male , Middle Aged , Young Adult , Age Factors , Asian People , Eye Infections/diagnosis , Incidence , Prevalence , Seasons , Spirurida Infections/diagnosis , Thelazioidea/isolation & purificationABSTRACT
Se realizó un estudio explicativo cuasiexperimental, con el objetivo de diseñar un sistema de actividades educativas para perfeccionar el diagnóstico y tratamiento integrado de las afecciones oftalmológicas a los pacientes geriátricos en la clínica oftalmológica José Martí, de Ecuador, en el período comprendido entre febrero y diciembre de 2008. Se aplicaron cuestionarios a 8 residentes, 2 especialistas en Medicina General Integral y 1 optometrista, que realizan pesquisa activa y pasiva.Se creó un grupo focal integrado por especialistas de oftalmología, farmacéutico y director de la clínica, para diseñar los protocolos terapéuticos y un plan de actividades avanzadas para elevar el conocimiento de las afecciones oculares en los médicos y pacientes. Se realizaron recomendaciones para incrementar la asesoría facultativa, con la participación de los pacientes adultos mayores, para mejorar la educación sanitaria de estos pacientes y un programa de acción para diagnóstico precoz y prevención.Una vez aplicado el sistema de actividades, se constató la aplicación de los protocolos terapéuticos integrados de las enfermedades oftalmológicas más frecuentes diagnosticadas en la clínica, a través de un examen oftalmológico óptico/instrumental...
We carried out a quasi experimental explicative study, with the objective of designing a system of educative activities to improve the integrated diagnosing and treatment of the ophthalmologic diseases of the geriatric patients at the ophthalmologic clinic José Martí, Ecuador, in the period from January to December 2008. 8 residents, 2 specialists in General Integral Medicine and 1 optometrist, who carry out active and passive investigations, answered our questionnaires. We created a focal group integrated by Ophthalmology specialists, a druggist and the director of the clinic, to design the therapeutic protocols and a plan of advanced activities to improve the ocular illnesses knowledge among physicians and patients. Recommendations were given to increase facultative advisement, with the participation of elder patients, to improve these patients' health education and an action program for precocious diagnosis and intervention. Once the system applied, we stated the application of the integrated therapeutic protocols of the ophthalmologic diseases more frequently diagnosed in the clinic through an optic/instrumental ophthalmologic examination...
Subject(s)
Humans , Adult , Aged , Health Knowledge, Attitudes, Practice , Ecuador , Eye Infections/diagnosis , Eye Infections/prevention & control , Eye Infections/therapy , Health Facilities , Health Personnel , Clinical ProtocolsSubject(s)
Biopsy , Corneal Ulcer/diagnosis , Eye Infections/diagnosis , Humans , Practice Guidelines as Topic , Specimen HandlingABSTRACT
La infección por citomegalovirus solamente es sintomática en un 2 por ciento de los recién nacidos vivos. Sin embargo, la expresión clínica es generalmente desbastante en el neonato, ocasionando procesos de Síndrome de Respuesta Inflamatoria Sistémica hasta generar daños irreversibles como ceguera por coriorretinitis y retardo psicomotor. El tratamiento de los casos sintomáticos se realiza a través de un inhibidor de la replicación viral como lo es el ganciclovir; cuya vía de administración es exclusivamente endovenosa, teniendo que hospitalizar al paciente por espacio de un intervalo mínimo de 21 días; ocasionando costos de hospitalización, riesgos de sobreinfección por agentes nosocomiales y separación temporal de la madre. Se presenta el siguiente caso de una lactante con coriorretinitis congénita, ocasionado por citomegalovirus, por comprobación de Reacción de Cadena de Polimerasa. Se inicia tratamiento ambulatorio con valganciclovir a una dosis de 30mg/kg/día. A los 03 meses del tratamiento, se realiza control de la actividad del citomegalovirus por Reacción de la Cadena de Polimerasa, la cual reporta negativa. Entre los efectos adversos se apreció un incremento leve de las transaminasas, las cuales se mantuvieron en dichos niveles a lo largo del tratamiento. No se observaron citopenias con el tratamiento ni otros efectos de importancia. El valganciclovir, una prodroga del ganciclovir, puede ofrecer una alternativa viable para el manejo de este tipo de pacientes, restando gastos de hospitalización y otras complicaciones derivadas a la vía endovenosa, pero con igual efecto terapéutico.
Subject(s)
Humans , Female , Infant , Cytomegalovirus/pathogenicity , Chorioretinitis/congenital , Chorioretinitis/diagnosis , Chorioretinitis/pathology , Ganciclovir/therapeutic use , Eye Infections/diagnosis , Eye Infections/therapy , Blindness/etiology , Ganciclovir/pharmacology , Ophthalmology , Pediatrics , Polymerase Chain Reaction/methods , Transaminases/analysisABSTRACT
Standard recommended guidelines for diagnosis of infectious keratitis do exist. Based on an extensive Medline literature search, the various investigative modalities available for aiding the diagnosis of microbial keratitis have been reviewed and described briefly. Preferred practice patterns have been outlined and the importance of routine pre-treatment cultures in the primary management of infectious keratitis has been highlighted. Corneal scraping, tear samples and corneal biopsy are few of the specimens needed to carry out the investigative procedures for diagnosis and for initiating therapy in cases of microbial keratitis. In bacterial, fungal and amoebic keratitis, microscopic examination of smears is essential for rapid diagnosis. Potassium hydroxide (KOH) wet mount, Gram's stain and Giemsa stain are widely used and are important for clinicians to start empirical therapy before microbial culture results are available. The usefulness of performing corneal cultures in all cases of suspected infectious keratitis has been well established. In cases of suspected viral keratitis, therapy can be initiated on clinical judgment alone. If a viral culture is needed, scrapings should directly be inoculated into the viral transport media. In vivo confocal microscopy is a useful adjunct to slit lamp bio-microscopy for supplementing diagnosis in most cases and establishing early diagnosis in many cases of non-responding fungal and amoebic keratitis. This is a non-invasive, high resolution technique which allows rapid detection of Acanthamoeba cysts and trophozoites and fungal hyphae in the cornea long before laboratory cultures give conclusive results. Other new modalities for detection of microbial keratitis include molecular diagnostic techniques like polymerase chain reaction, and genetic finger printing by pulsed field gel electrophoresis.
Subject(s)
Biopsy , Corneal Ulcer/diagnosis , Eye Infections/diagnosis , Humans , Practice Guidelines as Topic , Specimen HandlingABSTRACT
For the purpose of this symposium, the term "keratitis" implies suppurative nonviral and viral keratitis. Corneal ulcers have been described in ancient literature. But even today, despite the availability of a wide range of newer antimicrobials and new diagnostic techniques, infective keratitis continues to pose a diagnostic and therapeutic challenge. This article focuses on the key diagnostic clinical features of the most common organisms causing infective keratitis - bacteria, fungi, viruses, nocardia and acanthamoeba - in India. While the clinical features in some cases are fairly straightforward, most cases challenge the clinician. We describe the salient clinical features which can help arrive at a diagnosis to begin appropriate treatment immediately, prior to the laboratory report.
Subject(s)
Corneal Ulcer/diagnosis , Eye Infections/diagnosis , HumansABSTRACT
Human immunovirus infection in India is rapidly increasing. Ocular lesions due to highly active antiretroviral therapy have been well recognized. Acquired immunodeficiency syndrome can affect all parts of the eye. However, posterior segment lesions are the most common and of these, Human immunodeficiency virus retinopathy and cytomegalovirus retinitis predominate. Often clinical examination can establish the diagnosis of many ocular lesions in acquired immunodeficiency syndrome; therefore, ophthalmologists need to be aware of the more common ones. Various drugs in different routes can used to treat cytomegalovirus retinitis. Highly active antiretroviral therapy has remarkably reduced systemic and ocular morbidity among acquired immunodeficiency syndrome patients. To facilitate care of these patients aseptic precautions for ophthalmic care personnel are now well established and therefore ophthalmologist should not hesitate to provide ophthalmic care to acquired immunodeficiency syndrome patients.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Diagnosis, Differential , Eye Infections/diagnosis , HIV-1 , HumansABSTRACT
La sífilis ocular es una manifestación de la etapa secundaria de la lúes adquirida general y que en el ojo puede simular una gran variedad de cuadros oftalmológicos: su presentación más frecuente es la uveítis asociada a vasculitis de tipo arterítico, no es infrecuente de apreciar en pacientes inmunocomprometidos corioretinitis de tipo necrotizante a nivel del polo posterior del globo ocular. Siempre debe realizarse una evaluación multidisciplinaria tanto para su disgnóstico como tratamiento. Se recomienda realizar siempre una punción lumbar para descartar compromiso neurológico y realizar pruebas no treponémicas tituladas (con dilución) y FTA ABS. En la presentación ocular el tratamiento debe ser agresivo con altas dosis de penicilina, lo más precoz y oportuno, con el objetivo de evitar lesiones retinales irreversibles que pueden conducir a déficit visual importante
Subject(s)
Humans , Eye Infections/etiology , Neurosyphilis/diagnosis , Syphilis/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , Chile/epidemiology , Diagnosis, Differential , Eye Infections/diagnosis , Penicillins/therapeutic use , Syphilis/epidemiology , Syphilis/etiology , Syphilis/drug therapy , Syphilis Serodiagnosis , Treponema pallidum/isolation & purification , Treponema pallidum/pathogenicity , Uveitis/etiologyABSTRACT
Diversas especialidades médicas, em maior ou menor grau, estäo se deparando com a AIDS, envolvidas nos planos diagnósticos, terapêuticos, profiláticos e de investigaçäo. O oftalmologista tem papel de destaque no diagnóstico e na orientaçäo terapêutica de algumas condiçöes clínicas da AIDS. As complicaçöes oculares mais comuns nos pacientes com AIDS decorrem, quase sempre, da exacerbaçäo de processos infecciosos latentes, adquiridos em época anterior à imunodepressäo. Essas infecçöes tendem a se disseminar, causando manifestaçöes sistêmicas variadas, com quadros clínicos nem sempre característicos. O acometimento ocular é uma mera manifestaçäo local da disseminaçäo do processo e a avaliaçäo oftalmológica auxilia no estabelecimento do diagnóstico, uma vez que as alteraçöes verificadas no exame fundoscópico podem ser indicativas da etiologia do processo. Nesse sentido, é feita uma revisäo de alguns aspectos da AIDS que podem ser do interesse do oftalmologista.
Subject(s)
Humans , Male , Female , Eye Infections/complications , Ophthalmology , Acquired Immunodeficiency Syndrome/epidemiology , Diagnosis, Differential , Eye Infections/diagnosis , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
Avaliamos, retrospectivamente, 33 portadores de endoftalmites tratados clinicamente na Faculdade de Medicina de Botucatu. Observamos que 81,8 por cento dos pacientes eram do sexo masculino, a maioria com idade superior a 60 anos. A principal causa de endoftalmite foi o trauma (42,4 por cento). A gravidade das endoftalmites pode ser sentida ao observarmos que nenhum paciente apresentou recuperaçäo visual no término do tratamento.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Endophthalmitis , Eye Infections/diagnosis , Corneal Edema/diagnosis , Hyperemia , Visual AcuityABSTRACT
La toxocariasis es una infección por un nematodo que tiene dos formas clínicas de manifestarse: larva migrans visceral y toxocariasis ocular. estas últimas es casi exclusivamente unilateral y típica de la edad infantil; sin embargo, se ha descrito en individuos desde los 2 a los 40 años de edad. Puede presentarse con disminución de la visión, estrabismo, leucocoria o uveítis. Más frecuente es la presencia de un granuloma subrretiano en el polo posterior, o bien un granuloma coriorretiniano periférico. Menos frecuente es la existencia de una endoftalmitis con desprendimiento de retina. Las tres formas de afección ocular presentan las mismas patogenia. Presentamos dos casos clínicos correspondientes a un granuloma coriorretiniano periférico en un varón de 42 años de edad, y a un granuloma de polo posterior en un varón de 29 años. En ambos pacientes el diagnóstico se realizó fundamentalmente por los signos y síntomas, el aspecto clínico típico del fondo de ojo y los antecedentes personales
Subject(s)
Humans , Male , Adult , Eye Infections/etiology , Granuloma/etiology , Toxocariasis/complications , Endophthalmitis/etiology , Eye Infections/diagnosis , Granuloma/diagnosis , Larva Migrans/etiology , Toxocara canis/pathogenicity , Toxocariasis/diagnosis , Toxocariasis/etiology , Uveitis/etiologyABSTRACT
Human immunodeficiency virus infection is the first major pandemic of the 20th century. At present, almost 10 million people are known to be infected with this virus, and it is estimated that by the year 2000, approximately 40 million people will be infected. Transmission of this deadly infection is predominantly by sexual contact. Individuals infected with this virus pass through several predictable stages with progressive decrease in circulating CD4+ T cells. During the advanced stage, these patients develop various opportunistic infections or malignancies, or both. It is this advanced stage that was first recognized as AIDS, which has a 100% mortality rate. The opportunistic organisms that can involve the eye in patients with AIDS include cytomegalovirus, herpes zoster, Toxoplasma gondii, Mycobacterium tuberculosis, Cryptococcus neoformans, Mycobacterium avium-intracellulare, Pneumocystis carinii, Histoplasma capsulatum, Candida, and others. Intraocular lesions from these agents often represent disseminated infections. Visual morbidity occurs secondary to retinitis due to cytomegalovirus, herpes zoster, or Toxoplasma gondii. Anti-viral agents such as ganciclovir or foscarnet are effective against cytomegalovirus infection. The role of the ophthalmologist in the diagnosis and management of AIDS is becoming increasingly important. Not only does the eye reflect systemic disease, but ocular involvement may often precede systemic manifestations. In the AIDS patient, the ophthalmologist thus has an opportunity to make not only a slight-saving, but also life-saving diagnosis of disseminated opportunistic infections.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Eye Diseases/diagnosis , Eye Infections/diagnosis , Fundus Oculi , HumansSubject(s)
Humans , Endophthalmitis/etiology , Eye Infections/etiology , Administration, Topical , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections/diagnosis , Eye Infections/drug therapy , Microbial Sensitivity TestsABSTRACT
We examined 997 leprous outpatients, 528 of wich (53,0 por cento) were of the lepromatous type 199 (20,0 por cento) of the borderline type, 167 (16,8 por cento) of the tuberculoid type and 103 (10,3 por cento) of the indeterminate type. 579 (58,1 por cento) were male and 418 (41,9 por cento) were female, 314 patients (31,5 por cento) showed ocular adnexa lesions and 389 (39,0 por cento) showed ocular lesions. Ocular manifestations were more common in lepromatous leprosy and increased according to the age of the patients and the duration of disease. Evebrow madarosis (211 cases, 21,2 por cento) was the commonest lesion of the adnexa and iris atropy (255 cases, 25,6 por cento), the commonest ocular lesion. Sight threatening lesion, such as lagophtalmos (2 cases, 1,2 por cento), corneal anesthesia (121 cases, 12,1 por cento) and corneal ulcers (2 cases, 0,2 por cento), acute iritis (2 cases, 0,2 por cento) and chronic iritis (6 cases, 0,6 por cento) were rare findings. This low incidence of sight threatning lesions was in part considered to be due to the early systemic treatment
Subject(s)
Statistics on Sequelae and Disability , Leprosy , Eye Infections/diagnosis , Eye Infections/physiopathologyABSTRACT
Estudio comparativo entre un grupo de 40 ninos con disminucion de la agudeza visual y otro similar en tamano, edad y escolaridad, sin disminucion de la agudeza visual, para identificar los factores de riesgo para alteraciones de la vision. La informacion se recolecto mediante una untrevista estructurada a los padres que permitio identificar signos y sintomas de antecedentes de infeccion ocular, estrabismo, e iluminacion habitual del lugar donde el nino ve television. Para registrar los datos, se empleo un formato previamente disenado que facilito el analisis. El riesgo, se estudio cualitativamente en forma separada y posteriormente se establecieron relaciones de asociacion por razon de disparidad y prueba de significancia. En referencia a infeccion ocular se encontro asociacion con disminucion de la agudeza visual, pero fue mayor entre esta y estrabismo. No se encontro significativo como factor de riesgo el ver television con la luz ambiental apagada. Estos hallazgos revelan la importancia de reforzar los habitos higienicos en la familia y en el nino, y de ensenar a los padres a detectar tempranamente infeccion ocular y estrabismo como estrategias para prevenir la disminucion de la agudeza visual en escolares
Subject(s)
Child , Humans , Male , Female , Vision Disorders , Vision Screening , Visual Acuity , Eye Infections/complications , Eye Infections/diagnosis , Eye/anatomy & histology , Eye/physiology , Radiation, Nonionizing/adverse effects , Risk Factors , Strabismus/complicationsABSTRACT
This study is based on the observation of 363 patients bearing different types of hansen's diseases, and it was performed on a small community in the sate of Minas Gerais (municipality of Betim, MG). In examining a patient we had no previous knowledge as to the type of leprosy to expect. Therefore, we were able to study all of our patients free of umbiased ideas and without the danger of being influenced by a prevous diagnosis. The protocol, which was closely followed in every detail, was brokendown as follows: visual acuity, facial muscle functions, eyebrown, eyelashes, lacrimal apparatus, pupil, ocular motility, cornea sensibility, schimer test, a through study of the anterior segment of the eye with a slit-lamp Haag Streit - 900 and photo documentation (Nikon slit-lamp). In addition to theses particularities, several hystopathologic studies were carried out on parts of an enucleated eye