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ENDOPHTHALMITIS

OVERVIEW

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Causes

Patients aged over 85 who have had cataract surgery seem to be at a greater risk of this condition. It is however rare among others who have had a cataract surgery affecting only 0.1% cases of cataract surgery. Cases of Endophthalmitis after a blood infection are even rarer. Around 2 to 15% of all endophthalmitis cases are caused due to infections borne in blood.

Endophthalmitis Can Occur :

  • After a surgery due to injury caused during the surgery
  • After an injury to the eye due to bacterial or fungal infection leading to bacterial or fungal Endophthalmitis
  • Due to a generalized infection in the blood caused by fungus or bacteria
  • After corneal infection caused by microbial keratitis or infection of the cornea

Patients aged over 85 who have had cataract surgery seem to be at a greater risk of this condition. It is however rare among others who have had a cataract surgery affecting only 0.1% cases of cataract surgery. Cases of Endophthalmitis after a blood infection are even rarer. Around 2 to 15% of all endophthalmitis cases are caused due to infections borne in blood.

Risk factors of Endophthalmitis :

  • Surgery of the eye especially in presence of an active eye infection like bacterial conjunctivitis. Other risks due to surgery include poor surgical technique and contaminated surgical instruments
  • Accidental injury to the eye especially if a foreign object is lodged in the eye
  • Those wearing contact lenses with poor maintenance of hygiene
  • Those with corneal ulcers
  • Elderly individuals with poor immune reactions
  • Distant infections or blood infections and sepsis
  • Suppressed immunity due to infections and diseases like AIDS and medication use
  • Drug abusers

Symptoms

  • One of the most common features includes a red and inflamed eye.
  • There is blurring or decreasing vision
  • There is pain in the eye. Endophthalmitis may also be present without pain.
  • The patient usually provides a history of ocular surgery or trauma. Endophthalmitis after a surgery may present with sudden decrease of vision and increasing eye pain one to several days after surgery. Some cases may appear after a week to a month (or more) after surgery.
  • The patient may have a condition that has diminished his or her immunity.
  • The eye lid may appear swollen and the eye may appear red in acute cases while in long term or chronic cases there is gradual decrease of vision and gradually increasing redness and minimal or no pain.
  • Those patients who have a generalized infection leading to Endophthalmitis may have other features like fever, acute illness etc.

Diagnosis

A detailed history and examination of the eye is undertaken for diagnosis. The eye appears swollen and the conjunctiva appears red and suffused. The physician may also note presence of a pus spot in the anterior chamber of the eye. This is viewed by a slit lamp. Slit-lamp examination also shows severe inflammation in the anterior chamber and the vitreous especially in early post operative Endophthalmitis.
Fungal Endophthalmitis is caused by fungi like Candida. These may be present in patients with AIDS or those after an eye injury. The patient complains of presence of floaters or moving objects in vision, pain in both eyes. On examination using an ophthalmoscope there are presence of fluffy yellow-white retina lesions that appear as cotton balls with or without bleeding points over the retina.
Endophthalmitis caused due to microbial keratitis shows damage to the cornea. These are usually associated with contact lens wear especially with extended wear and poor hygiene. There may also be tear film deficiency or long term use of steroid drops in the eyes.

Diagnosis thus includes examination with –

  • Slit lamp
  • Ultrasound scan to check for the inner structures of the eye ball
  • Blood tests to check for infections
  • Culture of microorganisms affecting the eye or the blood (using blood cultures)
  • Polymerase chain reaction (PCR) tests for detecting fungal and bacterial infections
  • CT or MRI scan of the eye ball to look at the structures around the eye

Complication

Possible complication includes loss of vision. There may be chronic pain as well. In most cases however treatment may lead to a good response. To prevent Endophthalmitis after an operation, adequate care and treatment of pre-existing infections as well as maintenance of operative hygiene is important.

Treatment

Hospital admission is usually necessary for patients with Endophthalmitis. Delay or lack of adequate treatment may lead to loss of vision. After an eye injury a tetanus immunization is given to prevent tetanus. Treatment is usually targeted towards the cause of the condition –

  • Endophthalmitis due to inflammatory conditions is treated using steroids that helps reduce inflammation. The steroids may be given as drops or as pills. They are started in high diseases and doses are reduced as the condition improves until they are stopped. Severe cases may need injections of steroids around the affected eye ball.
  • For infections specific antibiotics or antifungal agents are prescribed. These may also be given as eye drops or as eye ointments or as pills and injections.
  • Dilators of pupils are given to relieve the pain caused by spasm of the iris muscles and to break the attachments or synechiae of the iris to the underlying structures.
  • Surgery may be needed in severe cases. In some patients the vitreous humor may be removed by a vitrectomy. This also reduces the inflammation and infection load.
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