Presenting symptoms and physical signs include ocular pain with visual loss, lid edema, conjunctival irritation, and hypopyon. Systemic antibiotics, usually indicated, are necessary in endogenous disease resulting from bacteremia. Diabetes is the leading cause of lower extremity amputation in the United States. Sensory and motor neuropathy results in unrecognized trauma and foot deformities which predispose the patient to ulcer formation. Furthermore, peripheral vascular disease may impede healing and antibiotic tissue penetration.
Appropriate shoes are important for patients with neuropathy.
Shoes with cushioned soles may suffice in some. In patients with foot deformity molded shoes or those with extra depth may be necessary. Changing shoes and socks every 3 to 4 hours permits inspection of the feet and rotation of pressure points. Foot ulcers in patients with diabetes should be treated in consultation with someone trained in this area. Attempts at outpatient management of foot ulcers should only be considered when the ulcer is superficial, erythema minimal, there is no evidence of ischemia or systemic toxicity, and conditions for home care are favorable.