Ophthalmologic Manifestations of Diphtheria Clinical Presentation

  • Author: Andrew A Dahl, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 30, 2012
 

History

Diphtheria begins as a respiratory infection with strident coughing and fever.

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Physical

  • Ocular manifestations of diphtheria, as those involving other organ systems, are both a result of the primary infection (keratoconjunctivitis) and the release of exotoxin (motility disorders).
    • In the eye, conjunctival infection may be mild, resembling a viral conjunctivitis with preauricular adenopathy, palpebral and bulbar conjunctival erythema and edema, and a moderate amount of yellowish discharge.
    • The more typical diphtheric infection is that of membranous conjunctivitis. Infiltration of the conjunctival surface leads to extreme edema and erythema of the eyelids with increasing stiffness of the lids. Membrane formation occurs over the palpebral and bulbar conjunctivae, and the membrane ultimately becomes necrotic and sloughs off, leaving behind severe conjunctival scarring with formation of symblepharon, entropion, trichiasis, and tear production disturbances. The conjunctiva may become necrotic, and thrombosis of perilimbal vessels can lead to corneal ulceration and scarring and to corneal perforation from corneal ischemia.
  • Up to 25% of patients with severe primary disease develop neurotoxicity from the effects of the exotoxin. Local paralysis of the soft palate and posterior pharyngeal wall are most common with other cranial neuropathies, leading to oculomotor and ciliary paralysis and facial and laryngeal weakness. Peripheral neuropathy may occur 10 days to 3 months postinfection, with proximal motor neuropathy initially, then moving distally, commonly involving dorsiflexors of the foot.
  • Oculomotor palsy and abducens palsies may be unilateral, bilateral, complete, or incomplete. Facial nerve paralysis may cause difficulties with eyelid closure. Paralysis of accommodation is common, occurring in approximately 10% of patients with diphtheria. Pupillary reactions remain normal. Usually, resolution of these cranial neuropathies occurs spontaneously within 2-6 weeks.
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Causes

Diphtheria is an acute infectious disease caused by the gram-positive bacillus C diphtheriae.

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Contributor Information and Disclosures
Author

Andrew A Dahl, MD  Director of Ophthalmology Teaching, Mid-Hudson Family Practice Institute, The Institute for Family Health; Assistant Professor of Surgery (Ophthalmology), New York College of Medicine

Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Louis E Probst  MD, Medical Director, TLC Laser Eye Centers

Louis E Probst is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery

Disclosure: Nothing to disclose.

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.

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