Actinomycosis in Ophthalmology Treatment & Management

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

Medical Care

See the list below:

  • Keratitis: Actinomycetes are usually susceptible to penicillins and cephalosporins. [37, 38, 39, 40] The treatment of keratoactinomycosis used to be excision of necrotic tissue, followed by cauterization. However, good results have been obtained by subconjunctival penicillin coadministered with systemic iodides. Alternatively, topical sulfacetamide or penicillin can be used.

  • Canaliculitis: Actinomycetes are usually susceptible to penicillins and cephalosporins. Postoperatively, patients may be treated with topical cefazolin for 1 month. Adjunctive hyperbaric oxygen therapy for actinomycotic lacrimal canaliculitis has been reported. [41]

  • Endophthalmitis: Intraocular, periocular, topical, and systemic therapy.

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Surgical Care

See the list below:

  • Keratitis: All reported cases of keratoactinomycosis responded to therapy, which included intraocular, topical, and systemic antibiotics, as well as pars plana vitrectomy and partial iridectomy. Urgent keratoplasty for a corneal infection by Actinomyces species was reported in a 41-year-old man.

  • Canaliculitis

    • Failure to resolve canaliculitis by using topical treatment requires surgical exploration of the canalicular system and removal of any casts. [8, 15] Extensive surgery is not always required.

    • A 2-snip punctoplasty, cast removal, curettage, probing, and adjunctive antibiotic therapy usually result in resolution of the canaliculitis.

    • Lee et al in 2009 presented a 1-snip punctoplasty and canalicular curettage. The affected punctum is incised along the posterior wall vertically. A chalazion curette is inserted into the canaliculus, and the concretions are evacuated. [42]

    • Cultivation of the surgically obtained dacryoliths and secretion enables reliable proof of Actinomyces and allows for an appropriate therapy for canaliculitis. Even though Actinomyces species are sensitive to penicillin, cure of canaliculitis does not occur until all the concretions and the granulations that are present in the canaliculus are meticulously removed.

  • Endophthalmitis: A diagnostic and therapeutic, 3-port, pars plana vitrectomy may be performed in cases where a diagnosis has not been achieved. [25]

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Consultations

An external disease and cornea specialist may provide care for the anterior segment.

An oculoplastics consult may be required for eyelid and orbital involvement.

A posterior segment surgeon is necessary for endophthalmitis.

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