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Endophthalmitis is an inflammation of the internal coats of the eye. It is a possible complication of all intraocular surgeries, particularly cataract surgery, with possible loss of vision and the eye itself. Infectious etiology is the most common and various bacteria and fungi have been isolated as the cause of the endophthalmitis. Other causes include penetrating trauma and retained intraocular foreign bodies.
Signs and symptoms
In cases of endophthalmitis, one usually finds a history of recent intraocular surgery or penetrating ocular trauma. In some cases of metastatic endophthalmitis—particularly in immunocompromised patients or those with diabetes—the spread of infection may have been hematogenous (via the blood-stream).
Endophthalmitis is usually accompanied by severe pain, loss of vision, and redness of the conjunctiva and the underlying episclera. Also present are signs of inflammation of the various coats of the eye. Hypopyon can be present in endophthalmitis and should be looked for on examination by a slit lamp.
An eye exam may be indicated in severe forms of candidiasis. 1-3% of cases of candidal blood infections include endophthalmitis.
- Bacteria: N. meningitidis, Staphylococcus aureus, S. epidermidis, S. pneumoniae, other streptococcal spp., Pseudomonas aeruginosa, other gram negative organisms.
- Viruses: Herpes simplex virus.
- Fungi: Candida spp.
- Parasites: Toxoplasma gondii, Toxocara.
Late onset endophthalmitis is mostly caused by Proprionobacterium acne.
- Panophthalmitis — Progression to involve all the coats of the eye.
- Corneal ulcer
- Orbital cellulitis
- no light perception vision
The patient needs urgent examination by an ophthalmologist and/or vitreo-retina specialist who will usually decide for urgent intervention to provide intravitreal injection of potent antibiotics and also prepare for an urgent pars plana vitrectomy as needed. Enucleation may be required to remove a blind and painful eye.
A Cochrane Review sought to evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery. Separate studies from the research showed that a periocular injection of penicillin with chloramphenicol-suphadimidine eye drops, and an intracameral cefuroxime injection with topical levofloxacin resulted in a risk reduction of developing endophthalmitis following cataract surgery for subjects.
- Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott's Diagnostic Microbiology. 12th Edition. Mosby Elsevier, 2007. p. 834.
- Goldenberg DT, Harinandan A, Walsh MK, Hassan T (Spring 2010). "Serratia Marcescens Endophthalmitis After 20-Gauge Pars Plana Vitrectomy". RETINAL Cases & Brief Reports 4 (2): 140–2. doi:10.1097/ICB.0b013e31819955bf.
- Gower EW, Lindsley K, Nanji AA, Leyngold I, McDonnell PJ (2013). "Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery". Cochrane Database Syst Rev 7 (7): CD006364. doi:10.1002/14651858.CD006364.pub2. PMID 23857416.
- Christy NE, Sommer A (1979). "Antibiotic prophylaxis of postoperative endophthalmitis". Ann Ophthalmol 11 (8): 1261–1265. PMID 318049.
- Endophthalmitis Study Group, European Society of Cataract and Refractive Surgeons (2007). "Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors". J Cataract Refract Surg 33 (6): 978–988. doi:10.1016/j.jcrs.2007.02.032. PMID 17531690.