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Eyes, Ears, and Nose


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What are the 4 usual defense mechanisms for the eyes?
1. Constant bath
2. Lysozomal, sIgA secretions
3. Eyelashes
4. 7 epithelial layers make bacterial penetration hard.
What 4 eye infections mostly present with eye specimens?
1. Conjunctivitis
2. Keratitis
3. Endophalmitis
4. Periocular infections
What is conjunctivitis, and what symptoms associate with it?
Inflammed conjunctiva; redness, itching, discharge.
What is Keratitis, and what symptoms are associated w/ it?
Corneal inflammation; usually from trauma, pain and impaired vision.
What is endophalmitis?
What 2 things usually cause it?
What symptom accompanies it?
-Any intraocular inflammation.
-Trauma and systemic infection.
-Pain when moving eyes.
What type of specimen usually comes with an eye infection?
Endophalmitis: ASPIRATE
Any other: swab
How do you process an eye specimen?
Inoculate BA and CA

For endophthalmitis, also inoculate anaerobic and thio broth; and do direct smear.
What are normal flora in the eyes?
Very small numbers of
-Coag neg staphs
What usually causes Conjunctivitis?
-Haemophilus aegyptius/influenz.
-Strep pneumo
-Staph aureus
-Nonferm GNB
-N. gonorrhoeae
-C. trachomatis
What usually causes keratitis?
-S. aureus
-S. pneumo
-Ps. aeruginosa
What pathogen usually causes periocular infections?
Staph aureus.
What mostly causes endophthalmitis?
S. aureus
Post op: staph epi/aureus, gnb, Streps.
What are the usual defense mechanisms of the ears?
1. Skin and anatomy
2. Respiratory epithelium
What is Otitis externa?
Who usually gets it, and what symptoms are seen?
An external ear infection up to the eardrum.
-Mostly in kids, pain and may have a discharge.
What is Otitis media?
An middle ear infection - in the Eustachian tube.
Why do kids often get otitis media?
Because they have small eustachian tubes.
What is the course of infection in otitis media?
1. Small Eustachian tube.
2. Gets blocked by lymphoid tissue during upper resp infctn.
3. Negative pressure created, allows bacteria to enter.
4. WBC infiltration causes fluid pressure on eardrum.
What symptoms accompany otitis media?
What specimens are recieved from
-Otitis externa
-Otitis media
Externa: swab
Media: aspirate
What plate media should be inoculated for both?
BA, CA, and possibly fungal if requested.
What are normal flora in the outer ears?
What are external ear pathogens?
-Strep group A
-Staph aureus
-Molds (aspergillus niger)
What are 3 classical causes of otitis media?
-Strep pneumonia
-Moraxella catarrhalis
-Haemophilus influenzae
What are the normal defense mechanisms of the nose?
-sIgA, lysozyme
What infection usually presents with a nose specimen?
What usually causes the sinusitis?
Secondary to a cold, or viral upper resp infection.
How do colds/viruses cause sinusitis infections?
-Close off the sinus openings
-Normal flora infect sinuses.
What symptoms present with sinusitis?
Headache, facial pain, drainage down the pharynx.
What should be inoculated for a nose specimen?
Swab: BA, CA, CNA, maybe LEMB.

Sinus aspirate: also anaerobic media.
Would you do a direct smear of a nose specien?
Swab - no; lots of normal flora.
Aspirate - yes; sinuses should be sterile.
What are normal flora AND possible pathogens in the nose specimen?
-Strep pneumoniae
-Haemophilus influenzae

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