Actinomycosis in Ophthalmology Clinical Presentation

  • Author: Manolette R Roque, MD, MBA; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 20, 2012
 

History

  • Keratitis
    • Symptoms
      • Progressive visual haze
      • Increasing ocular pain
      • Photophobia
      • Constant watering
      • Redness
    • Past ocular history
      • Corneal trauma, especially when contaminated by vegetable matter
      • Ongoing, nonresponsive treatment
    • Personal history - Outdoor laborer
  • Canaliculitis
    • Symptoms[8, 9]
      • Chronic or recurrent conjunctivitis
      • Chronic mucopurulent discharge
      • Epiphora
      • Ocular surface irritation
      • Medial eyelid and canthal pain
      • Pouting punctum
      • Failure to resolve despite topical treatment
    • Past ocular history and medical history - Similar to keratitis
  • Endophthalmitis
    • Symptoms
      • Blurring of vision
      • Floaters
      • Ocular pain
      • Redness
      • Tearing
    • Past ocular history
      • Uneventful phacoemulsification with implantation of a foldable posterior chamber intraocular lens
    • Personal history
      • Elderly
      • Debilitated
Next

Physical

  • Keratitis
    • Gross observations
      • Some conjunctival congestion
      • Gray-white corneal lesion
    • Slit lamp findings
      • A dry ulceration with central necrosis, surrounded by a gutter of demarcation, usually accompanied by iritis, and hypopyon may be present.
      • Gray-white satellite stromal infiltrates adjacent to advancing edges may be present.
      • In severe cases, descemetocele and perforation may occur.
  • Canaliculitis[8, 9]
    • Gross observations
      • Chronic discharge, swollen and pouted punctum
      • A pouted punctum is clinically diagnostic, although it occurs in less than 50% of all patients who are affected.
      • Typically, the discharge is particulate and contains concretions.
      • The plica may be swollen and congested, and canalicular swelling and overlying lid erythema are often present.
      • The lower lid is more commonly affected, and the lacrimal sac and the duct are usually not involved.
    • Slit lamp findings
      • Pouted punctum
      • Plica may be swollen and congested.
      • Particulate canalicular discharge with or without concretions
    • Images of canaliculitisCanaliculitis of the left lower lid. Courtesy of PCanaliculitis of the left lower lid. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School. Canaliculitis of the right upper lid. Courtesy of Canaliculitis of the right upper lid. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School. A pediatric patient with canaliculitis. Courtesy oA pediatric patient with canaliculitis. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
  • Endophthalmitis
    • Gross observations
      • Conjunctival injection
      • Elevated tear meniscus
    • Slit lamp findings
      • Anterior chamber cells and flare
      • Hypopyon
      • Vitreous debris
Previous
Next

Causes

  • Infectious
    • Actinomyces species
    • See Background.
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Manolette R Roque, MD, MBA  General Manager, Full Partner, Ophthalmic Consultants Philippines Co.; President and CEO, Chief Refractive Surgeon, EYE REPUBLIC Ophthalmology Clinic; Section Chief, Ocular Immunology and Uveitis, Department of Ophthalmology, Asian Hospital and Medical Center; Section Chief, Ocular Immunology and Uveitis, International Eye Institute, St Luke's Medical Center Global City; Senior Eye Surgeon, The LASIK Surgery Clinic; Director, AMC Eye Center, Alabang Medical Center; President, Philippine Ocular Inflammation Society

Manolette R Roque, MD, MBA is a member of the following medical societies: American Academy of Ophthalmic Executives, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, American Society of Ophthalmic Administrators, American Uveitis Society, International Ocular Inflammation Society, Philippine Medical Association, Philippine Ocular Inflammation Society, and Philippine Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara L Roque, MD  Full Partner, Ophthalmic Consultants Philippines Co; Service Chief, Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Asian Hospital and Medical Center; Active Staff, International Eye Institute, St Luke's Medical Center Global City; Visiting Ophthalmologist, AMC Eye Center, Alabang Medical Center

Barbara L Roque, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Cataract and Refractive Surgery, Philippine Academy of Ophthalmology, Philippine Society of Cataract and Refractive Surgery, and Philippine Society of Pediatric Ophthalmolo

Disclosure: Nothing to disclose.

C Stephen Foster, MD, FACS, FACR, FAAO  Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Jorge G Camara, MD  Professor of Ophthalmology, Department of Surgery and Director of Fellowship Training Program in Ophthalmic Plastic and Reconstructive Surgery for Countries Served by the Aloha Medical Mission, University of Hawaii John A Burns School of Medicine

Jorge G Camara, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.

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Canaliculitis of the left lower lid. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
Canaliculitis of the right upper lid. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
A pediatric patient with canaliculitis. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
A patient presenting with pseudocanaliculitis secondary to a chalazion. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
A patient presenting with pseudocanaliculitis secondary to a chalazion. Courtesy of Peter Rubin, MD, Director, Eye Plastics Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
Actinomyces israelii (non–spore-forming, gram-positive bacilli). Courtesy of Medical Education Information Center, Department of Pathology and Laboratory Medicine, The University of Texas-Houston Medical School.
Actinomyces israelii. (The image is labeled.)
Actinomycosis.
Clinical slit-lamp photographs of Actinomyces infectious crystalline keratopathy (A) upon initial presentation, (B) immediately following first repeat penetrating keratoplasty, and (C and D) low and high magnification of recurrent corneal opacities 6 months later. White arrows highlight temporal opacity within host cornea.
 
 
 
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