Clinical Roles of Infectious Diseases Specialists in Ophthalmology

Ophthalmology is characterized by its organ-specific focus, reliance on specialized devices, and the requirement that intraocular examinations be performed exclusively by ophthalmologists. These factors limit interdisciplinary collaboration. However, infection screening prior to immunosuppressive therapy (IST), systemic infection management, and antimicrobial planning increasingly require input from infectious diseases (ID) specialists. This study aimed to analyze the indications and clinical outcomes of ID consultations initiated by ophthalmology subspecialties in a tertiary eye hospital.

This retrospective cross-sectional study evaluated ID consultations requested by ophthalmology units between December 2021 and February 2023. Patients aged ≥18 years referred for formal ID consultation were included; referrals made solely for topical antibiotic approval were excluded. Referrals were assessed by subspecialty, consultation indication, systemic antimicrobial therapy, need for prophylaxis, and additional testing. Findings were analyzed using descriptive statistics.

A total of 195 consultations were recorded. Consultation indications and patient age distributions differed significantly across ophthalmology subspecialties (p<0.001). Most referrals originated from the uvea unit (n=132, 67.7%), primarily for IST eligibility assessment (n=121, 91.7%). The oculoplastic surgery unit was most often consulted for antimicrobial therapy (n=23, 85.2%). Anterior segment referrals included 50% for treatment and 40% for preoperative evaluation. Half of the retina referrals were for differential diagnosis (n=4). Among uvea patients evaluated for IST (n=121), 66.1% received prophylaxis: 87.5% received antituberculosis prophylaxis, 27.5% hepatitis B prophylaxis, and 15% both. Systemic antimicrobial therapy was initiated in 92.6% of oculoplastic, 55% of anterior segment, and 37.5% of retina patients. Additional testing was frequently required for anterior segment and retina cases, and 25% of retina patients were referred to multidisciplinary centers.

Infectious diseases specialists play not only a supportive but also a guiding role in ophthalmic clinical decision-making. Their involvement significantly contributes to IST planning and systemic antimicrobial management. Variation across ophthalmology subspecialties highlights their role in both preventive and therapeutic care.