Endophthalmitis

Endophthalmitis is a severe and potentially sight-threatening inflammation of the interior of the eye, typically caused by infection. This condition requires immediate medical attention to prevent permanent vision loss. Understanding the causes, symptoms, diagnosis, and treatment options of endophthalmitis is crucial for anyone at risk or involved in eye care.

What Is Endophthalmitis?

Endophthalmitis is an inflammation of the intraocular cavities, usually resulting from an infection. It can be classified into two main types: acute and chronic.

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Types of Endophthalmitis: Acute vs. Chronic

Acute Endophthalmitis

Acute endophthalmitis typically manifests within days to weeks following eye surgery, trauma, or an intravitreal injection. Symptoms are sudden and severe, often including pain, redness, and significant vision loss.

Chronic Endophthalmitis

Chronic endophthalmitis, on the other hand, develops more slowly, over weeks to months. It often results from indolent infections, and its symptoms are more subtle and gradual. Chronic cases can be particularly challenging to diagnose due to their insidious nature.

Causes of Endophthalmitis

Endophthalmitis can result from various causes, most commonly categorized into exogenous and endogenous sources.

Exogenous Endophthalmitis

Exogenous endophthalmitis occurs when an infectious agent enters the eye from an external source. Common causes include:

Postoperative Infections: Occurring after eye surgeries such as cataract extraction, glaucoma surgery, or vitrectomy.
Post-traumatic Infections: Following penetrating eye injuries.
Intravitreal Injections: Used for treating retinal conditions, which can introduce pathogens into the eye.

Endogenous Endophthalmitis

Endogenous endophthalmitis arises when an infection from elsewhere in the body spreads to the eye via the bloodstream. It is often associated with systemic conditions like diabetes, immunosuppression, or intravenous drug use.

Symptoms of Endophthalmitis

Recognizing the symptoms of endophthalmitis is critical for timely diagnosis and treatment. Symptoms may vary depending on whether the condition is acute or chronic.

Common Symptoms

Severe Eye Pain: Often a hallmark of acute cases.
Redness: Generalized or localized to the area around the eye.
Blurred Vision: Can range from mild to profound vision loss.
Photophobia: Sensitivity to light.
Swelling of the Eyelids: May accompany the inflammation.
Hypopyon: The presence of white blood cells in the anterior chamber of the eye, visible as a white layer.

Diagnosis of Endophthalmitis

Timely and accurate diagnosis is essential for managing endophthalmitis. Diagnostic procedures include:

Clinical Examination

A comprehensive eye examination by an ophthalmologist is the first step. This includes assessing visual acuity, intraocular pressure, and a detailed slit-lamp examination to identify signs of inflammation and infection.

Laboratory Tests

Aqueous and Vitreous Samples: Obtained via anterior chamber paracentesis or vitreous tap to identify the causative organism.
Gram Stain and Culture: Essential for detecting bacterial or fungal pathogens.
Polymerase Chain Reaction (PCR): For rapid and precise identification of infectious agents, particularly in culture-negative cases.

Imaging Studies

Ultrasound B-scan: Useful for evaluating the posterior segment of the eye, especially when media opacities hinder direct visualization.

Treatment Options for Endophthalmitis

Immediate treatment is crucial for preserving vision and eradicating the infection. Treatment strategies include:

Intravitreal Injections

Administering antibiotics or antifungal agents directly into the vitreous cavity is the cornerstone of endophthalmitis treatment. Commonly used drugs include:

Vancomycin: Effective against gram-positive bacteria.
Ceftazidime: Targets gram-negative bacteria.
Amphotericin B or Voriconazole: For fungal infections.

Systemic Antibiotics

In cases of severe infection or when endogenous endophthalmitis is suspected, systemic antibiotics may be necessary to manage the infection.

Vitrectomy

A surgical procedure called pars plana vitrectomy may be required, particularly in severe or unresponsive cases. This involves removing the vitreous humor and replacing it with a sterile solution. Vitrectomy helps to:

Reduce the Infectious Load: By removing infected vitreous gel.
Improve Drug Penetration: By allowing better access for intravitreal antibiotics.
Clear Media Opacities: Improving visualization and assessment of the retina.

Supportive Care

Topical Antibiotics and Steroids: To control surface infection and inflammation.
Pain Management: Using analgesics to alleviate severe pain.

Risk Factors for Endophthalmitis

Certain factors increase the risk of developing endophthalmitis, including:

Surgical Procedures

Cataract Surgery: The most common cause of postoperative endophthalmitis.
Glaucoma and Vitreoretinal Surgery: Also associated with increased risk.

Medical Conditions

Diabetes Mellitus: Impairs immune response, increasing susceptibility to infections.
Immunosuppression: Due to medications or systemic conditions.

Trauma

Penetrating Eye Injuries: Create direct entry points for pathogens.

Intravitreal Injections

Frequent Injections: For conditions like age-related macular degeneration (AMD) or diabetic retinopathy.

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Preventive Measures

Preventing endophthalmitis involves meticulous surgical techniques and adherence to aseptic protocols. Key preventive measures include:

Preoperative and Intraoperative Measures

Povidone-Iodine Prep: Applying iodine solution to the conjunctiva and periocular skin before surgery.
Sterile Techniques: Maintaining a sterile environment and using sterile instruments.

Postoperative Care

Antibiotic Prophylaxis: Topical or systemic antibiotics may be used postoperatively.
Close Monitoring: Regular follow-up visits to detect and manage any early signs of infection.

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