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Review
. 2023 Nov 21;12(23):7216.
doi: 10.3390/jcm12237216.

From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections

Giacomo Visioli  1 , Marco Zeppieri  2 , Valeria Iannucci  1 , Priscilla Manni  1 , Giuseppe Maria Albanese  1 , Carlo Salati  2 , Leopoldo Spadea  1   3 , Maria Pia Pirraglia  3
Affiliations
Review

From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections

Giacomo Visioli et al. J Clin Med. .

Abstract

In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.

Keywords: bedside diagnosis; clinical practice; infection management; ocular fundus examination; ophthalmology consultation; systemic infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Examples of two real-world fundus examinations conducted in infectious disease wards and photographed using a smartphone camera. (A) shows a severe case of necrotizing herpetic retinopathy at the posterior pole. (B) despite vitreous opacity, a wide area of retinal exudate with hemorrhage at the edges near the optic nerve can be recognized. The patient was ultimately diagnosed with systemic nocardiosis.
Figure 2
Figure 2
The flowchart illustrates the clinical procedure for assessing and treating patients admitted for suspected systemic infections, indicating when an ocular fundus examination is advisable.
Figure 3
Figure 3
The flowchart visualizes the decision-making process following an ocular fundus examination in patients with systemic infections.
See this image and copyright information in PMC

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