Diferencia entre revisiones de «Hypopyon»
Sin resumen de edición |
(Expand: common causes, slit-lamp evaluation, ophthalmology consult before treatment) |
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==Background== | ==Background== | ||
*Collection of white blood cells (leukocytic exudate) layering in the anterior chamber of the eye | |||
*A sign of severe intraocular inflammation — not a diagnosis itself | |||
*Always indicates significant pathology requiring urgent evaluation | |||
*'''Most common causes in EM:''' [[corneal ulcer]] (infectious keratitis), severe [[uveitis]], [[endophthalmitis]] | |||
==Clinical Features== | ==Clinical Features== | ||
* | *White or yellow-white layering fluid visible at the dependent (inferior) portion of the anterior chamber | ||
* | *Best visualized on [[slit-lamp]] exam | ||
* | *Associated findings depend on etiology: | ||
**[[Eye pain]], photophobia, tearing | |||
**[[Red eye]], ciliary flush | |||
**Decreased visual acuity | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Corneal ulcer]] | *[[Corneal ulcer]] (infectious keratitis) — most common cause; look for corneal infiltrate/opacity | ||
*[[Uveitis]] | *[[Endophthalmitis]] — post-surgical or post-traumatic; vitreous involvement | ||
*[[Traumatic iritis]] (severe | *[[Uveitis]] (anterior) — may be idiopathic or associated with systemic disease | ||
*[[Behcet's disease]] | *[[Traumatic iritis]] (severe) | ||
* | *[[Behcet's disease]] — recurrent hypopyon with oral/genital ulcers | ||
*Intraocular tumor (rare) | |||
==Evaluation== | ==Evaluation== | ||
*Visual acuity | |||
*[[Slit-lamp]] exam: quantify hypopyon height (mm), assess cornea for ulcer/infiltrate, anterior chamber cells/flare | |||
*Fluorescein staining: rule out [[corneal ulcer]] | |||
*IOP measurement (may be elevated or low) | |||
*Dilated fundoscopic exam if endophthalmitis suspected (vitreous haze) | |||
*'''If corneal ulcer:''' Obtain corneal scrapings for culture before starting antibiotics (ophthalmology) | |||
==Management== | ==Management== | ||
*'''Emergent ophthalmology consult''' for all cases | |||
*Do not start treatment until ophthalmology evaluates (may need cultures first) | |||
*Treatment depends on underlying cause: | |||
**Infectious keratitis: Fortified topical antibiotics (ophthalmology-directed) | |||
**Uveitis: Topical steroids + cycloplegic (ophthalmology-directed) | |||
**Endophthalmitis: Intravitreal antibiotics ± vitrectomy | |||
==Disposition== | ==Disposition== | ||
*Emergent | *Emergent ophthalmology consult from ED | ||
*Most cases require close daily ophthalmology follow-up or admission | |||
==See Also== | ==See Also== | ||
[[Hyphema]] | *[[Hyphema]] | ||
*[[Corneal ulcer]] | |||
*[[Uveitis]] | |||
*[[Endophthalmitis]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
Revisión actual - 01:45 21 mar 2026
Background
- Collection of white blood cells (leukocytic exudate) layering in the anterior chamber of the eye
- A sign of severe intraocular inflammation — not a diagnosis itself
- Always indicates significant pathology requiring urgent evaluation
- Most common causes in EM: corneal ulcer (infectious keratitis), severe uveitis, endophthalmitis
Clinical Features
- White or yellow-white layering fluid visible at the dependent (inferior) portion of the anterior chamber
- Best visualized on slit-lamp exam
- Associated findings depend on etiology:
Differential Diagnosis
- Corneal ulcer (infectious keratitis) — most common cause; look for corneal infiltrate/opacity
- Endophthalmitis — post-surgical or post-traumatic; vitreous involvement
- Uveitis (anterior) — may be idiopathic or associated with systemic disease
- Traumatic iritis (severe)
- Behcet's disease — recurrent hypopyon with oral/genital ulcers
- Intraocular tumor (rare)
Evaluation
- Visual acuity
- Slit-lamp exam: quantify hypopyon height (mm), assess cornea for ulcer/infiltrate, anterior chamber cells/flare
- Fluorescein staining: rule out corneal ulcer
- IOP measurement (may be elevated or low)
- Dilated fundoscopic exam if endophthalmitis suspected (vitreous haze)
- If corneal ulcer: Obtain corneal scrapings for culture before starting antibiotics (ophthalmology)
Management
- Emergent ophthalmology consult for all cases
- Do not start treatment until ophthalmology evaluates (may need cultures first)
- Treatment depends on underlying cause:
- Infectious keratitis: Fortified topical antibiotics (ophthalmology-directed)
- Uveitis: Topical steroids + cycloplegic (ophthalmology-directed)
- Endophthalmitis: Intravitreal antibiotics ± vitrectomy
Disposition
- Emergent ophthalmology consult from ED
- Most cases require close daily ophthalmology follow-up or admission