Actinomycosis in Ophthalmology Clinical Presentation

Updated: Mar 15, 2016
  • Author: Manolette R Roque, MD, MBA, FPAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

History

See the list below:

  • 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
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Physical

See the list below:

  • 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 canaliculitis
      Canaliculitis of the left lower lid. Courtesy of P 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 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 o A 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
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Next:

Causes

See the list below:

  • Infectious
    • Actinomyces species
    • See Background.
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