Diagnosing the presence of specific microbial pathogens that are the likely cause of infectious disease in the eye.
Detecting a predominance of certain cell types (e.g., eosinophils, macrophages, epithelial ingrowth, ghost erythrocytes, phacolytic cells) that may provide a clue as to the etiology of an inflammatory disease, which may be autoimmune or allergic in nature.
Specific antibodies in the aqueous humor or vitreous aspirate that are suggestive of infection (e.g., Toxocara, Toxoplasma, herpesvirus, syphilis).
Proteins (e.g., lens proteins, angiotensin-converting enzyme) that are suggestive of granulomatous inflammation, such as sarcoidosis.
TABLE 35-1 Diagnostic Paracentesis
FIG. 35.2 Typical gram-positive cocci occurring in clusters as isolated from the aqueous of a patient with staphylococcal endophthalmitis.
FIG. 35.3 Chains of gram-positive cocci obtained from aqueous fluid in a patient with streptococcal endophthalmitis.
FIG. 35.5 Aqueous specimen demonstrating acid-fast bacilli of acute lepromatous leprosy in the aqueous aspiration of a patient with a profound anterior segment inflammation that presented as a diagnostic dilemma.
FIG. 35.6 Scleral nodule specimen showing a profuse number of acid-fast bacilli from a patient with lepromatous uveitis.
FIG. 35.7 Anterior segment photograph showing a petechiaespeckled hypopyon in a patient with profound anterior segment inflammation resulting from acute lepromatous leprosy.
FIG. 35.8 Inflamed scleral nodule removed from the same patient as in Figure 35.7, who had acute lepromatous uveitis.
FIG. 35.9 Trophozoites of toxoplasmosis in an aspirate from mouse peritoneum, which incubated acute material from a patient with acute acquired systemic toxoplasmosis with retinitis.
FIG. 35.10 Axillary lymph node of a patient with acquired systemic toxoplasmosis demonstrating trophozoites and a toxoplasma cyst.
FIG. 35.11 Vitreous aspirate demonstrating large cell lymphoma infiltration in a patient with vitreitis and masquerade uveitis of reticulum cell sarcoma or large cell lymphoma.
FIG. 35.12 Large cell lymphoma aspirate of vitreous. Immunofluorescence demonstrates a monoclonal infiltrate of lambda light chains on the B cells.
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