A B C D E F G H I J K L M N O P Q R S T U V W X Y Z #

Culture, Eye

Message
Positive cultures will reflex to identification and sensitivities as applicable.  Additional charges will apply.
 


Test Code
CXEYE


Alias/See Also
Eye, Eye Culture, Culture


CPT Codes
87070

Preferred Specimen
  • Conjunctival Scrapings
  • Corneal Scrapings
  • Intraocular Fluids
  • Swab of purulent discharge or Pus


Instructions

General Considerations: 
  1. Obtain viral and chlamydial samples before topical anesthetics are instilled.
  2. When swab is collected, obtain samples for bacterial, chlamydial and/or viral cultures on eye specimens using Dacron swabs with plastic shafts -- such as the aerobic culture swabs. Place swabs into viral/chlamydia transport media.
  3. SEE SEPARATE PROCEDURE FOR CHLAMYDIA EYE TESTING that is not culture, such as DNA Probe method.  This is usually on babies and is put into special GenProbe media for DNA probe testing - obtained from the Microbiology department at CRMC.  Check order carefully to obtain proper media.
  4. Usual specimen is collected by the opthalmologist.  Prepared smears and inoculated media are then sent to the laboratory immediately. 
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Physician inoculated conjunctival or ey lid culture designating Left or Right Physician inoculated corneal scraping “c” shaped design.
 
  1. Conjunctival scrapings.
    1. One or 2 drops of topical anesthetic are generally instilled.
    2. Scrape the lower tarsal conjunctiva with a sterilized Kimura spatula.
    3. Inoculate the appropriate media directly.
    4. Prepare smears by applying the scraping in a circular manner to a clean glass slide or by compressing material between two glass slides and pulling the slides apart.
    5. Alternatively, use a calcium alginate swab or a cotton-tipped applicator to swab the inferior tarsal conjunctiva (inside surface of eyelid) and the fornix of the eye. However, organisms are more readily detected in scrapings than from a swab.
  2. Corneal scrapings.
    1. Obtain conjunctival samples prior to corneal scrapings. Sometimes conjunctival cultures are helpful in assessing the possibility of contamination of corneal cultures.
    2. One or 2 drops of topical anesthetic are generally instilled.
    3. Using short, firm strokes in one direction, scrape multiple areas of ulceration and suppuration with a sterilized Kimura spatula. (Keep the eyelid open, and be careful not to touch the eyelashes).
    4. Inoculate each scraping directly to appropriate media. (Multiple scrapings are recommended because the depth and extent of viable organisms may vary).
    5. Prepare smears by applying the scrapings in a gentle circular motion over a clean glass slide or by compressing material between two clean glass slides and pulling the slides apart. Prepare 2 smears if possible.
  3. Intraocular fluid.
    1. Use a needle aspiration technique to collect intraocular fluid.
    2. Inoculate appropriate media directly, and/or immediately transport he samples to the laboratory in a capped syringe with air bubbles expelled. Refer to Table 1 for instructions on properly transporting specimens collected in a syringe.
    3. Prepare smears by spreading a drop of material over the surface of a cleaned glass slide with a sterile Kimura spatula or by compressing the material between two glass slides and pulling the slides apart.
  4. Conjunctiva (bacterial conjunctivitis) and lid margin (if staphylococcal blepharoconjunctivitis is suspected).
    1. Obtain the specimen with a sterile, premoistened cotton or calcium alginate swab.
    2. Roll the calcium alginate or cotton-tipped swab over the conjunctiva before topical medications are applied.
    3. Culture both eyes with separate swabs.
    4. Immediately inoculate the material at the bedside onto the media as described in Table 1 of this procedure.
    5. Inoculate the swab from the right conjunctiva to one plate labeled with an “R”, left conjuctiva on another plate labeled with an “L”.
    6. On another agar plate, if collected, inoculate specimens from the right and left lid margins.
    7. Instruct the ophthalmologist to obtain conjunctival scrapings for a smear preparation as follows.
      1. Instill 1 to 2 drops of proparacaine hydrochloride.
      2. Using a Kimura spatula, gently scrape across the lower right tarsal conjunctiva.
      3. Smear the material in a circular area 1 cm in diameter on a clean glass slide.
      4. Prepare at least two slide.
      5. Immediately transport inoculated media and slides to the laboratory.
      6. Lab: Flood the slides with 95% methyl alcohol for 5-10 min. to fix.
  5. Bacterial keratitis.
    1. Instruct the ophthalmologist to obtain corneal scrapings from the advancing edge of the ulcer with a sterile Kimura spatula as described below:
      1. Obtain approximately three to five scrapings per cornea.
      2. Inoculate each set of scrapings onto an agar plate (Table 1), using a C formation for each scraping.
      3. Smear scrapings onto two or three glass slides for staining.
      4. Immediately transport inoculated media and slides to the laboratory.
  6. Bacterial endophthalmitis.
    1. Instruct the physician to collect an aspirate of the vitreous fluid or to perform a paracentesis of the anterior chamber.
    2. Instruct the physician to collect specimens for conjunctival cultures along with the fluid to determine the significance of indigenous microbiota.
    3. If a small volume of fluid is collected, inoculate cultures at the bedside.
    4. Inoculate 1 or 2 drops of fluid onto culture media (Table 1).
  7. Preseptal cellulitis.
    1. Instruct the physician to cleanse the skin with alcohol and tincture of iodine or iodophor.
    2. In the absence of an open wound, the physician makes a stab incision in either the upper or lower lid with a no. 11 Baird-Parker blade.
    3. If there is an open wound, instruct the physician to collect the purulent material with a syringe and needle.
    4. Inoculate media (Table 1), and prepare slides as described above in Methods of Specimen Collection section.
    5. Inject some material onto an anaerobic transport swab, or send syringe with fluid to Lab ASAP.
  8. Orbital cellulitis.
    1. Obtain aspirate of the wound as described above.
    2. Collect blood cultures.
  9. Dacryoadenitis.
    1. Collect a specimen of the purulent discharge by using a swab as described above.
    2. Do not perform a needle aspiration of the lacrimal gland.
  10. Dacryocystitis.
    1. Obtain conjunctival cultures.
    2. Press the lacrimal sac to remove exudate material for culture and smear, or alternatively, collect exudate in needle and syringe.
    3. Place aspirated material on a transport swab, or send in capped syringe, and transport to the laboratory as described above.
  11. Canaliculitis.
    1. Compress the inner aspect of the eyelid to express pus.
    2. Follow procedure outlined above


Transport Container
  • Most Bacterial Eye Cultures:  Transport room temperature 25 degrees celsius
  • Chlamydia Eye Cultures:  Transport at refrigerator temperatures of 2-8 degrees celsius.


Setup Schedule
24x7


Report Available
3-4 days


Reference Range
No growth


Clinical Significance
Assessment for acute or chronic eye inflammatory conditions.


Performing Laboratory
CRMC Microbiology



The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.