Endophthalmitis
Encyclopedia
Endophthalmitis is an inflammation of the internal coats of the eye
. It is a dreaded 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.
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 indicated in severe forms of candidiasis
. 1-3% of cases of candidal blood infections include endophthalmitis.
as needed. Enucleation may be required to remove a blind and painful eye.
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
. It is a dreaded complication of all intraocular surgeries
Eye surgery
Eye surgery, also known as orogolomistician surgery or ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist.-Preparation and precautions:...
, particularly cataract surgery
Cataract surgery
Cataract surgery is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision...
, with possible loss of vision
Vision loss
Vision loss or visual loss is the absence of vision where it existed before, which can happen either acutely or chronically .-Ranges of vision loss:...
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
Conjunctiva
The conjunctiva covers the sclera and lines the inside of the eyelids. It is composed of rare stratified columnar epithelium.-Function:...
and the underlying episclera
Episclera
The episclera is the outermost layer of the sclera. It is composed of loose, fibrous, elastic tissue and attaches to Tenon's capsule.A vascular plexus is found between the conjunctiva and the sclera consisting of two layers of vessels, the superficial episcleral vessels and the deep episcleral...
. Also present are signs of inflammation of the various coats of the eye. Hypopyon
Hypopyon
Hypopyon is pus in the eye.It is a leukocytic exudate, seen in the anterior chamber, usually accompanied by redness of the conjunctiva and the underlying episclera. It is a sign of inflammation of the anterior uvea and iris, i.e. iritis, which is a form of anterior uveitis...
can be present in endophthalmitis and should be looked for on examination by a slit lamp
Slit lamp
The slit lamp is an instrument consisting of a high-intensity light source that can be focused to shine a thin sheet of light into the eye. It is used in conjunction with a biomicroscope...
.
An eye exam may indicated in severe forms of candidiasis
Candidiasis
Thrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...
. 1-3% of cases of candidal blood infections include endophthalmitis.
Complications
- PanuveitisUveitisUveitis specifically refers to inflammation of the middle layer of the eye, termed the "uvea" but in common usage may refer to any inflammatory process involving the interior of the eye....
or PanophthalmitisPanophthalmitisPanophthalmitis is the inflammation of all coats of the eye including intraocular structures....
- Progression to involve all the coats of the eye. - Corneal ulcerCorneal ulcerA corneal ulcer, or ulcerative keratitis, is an inflammatory condition of the cornea involving loss of its outer layer. It is very common in dogs and is sometimes seen in cats...
- Orbital cellulitisOrbital cellulitisOrbital cellulitisis an infection of eye tissues posterior to the orbital septum. It most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood...
- no light perception vision
Treatment
The patient needs urgent examination by an expert 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 vitrectomyVitrectomy
Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye. Anterior vitrectomy entails removing small portions of the vitreous from the front structures of the eye—often because these are tangled in an intraocular lens or other structures...
as needed. Enucleation may be required to remove a blind and painful eye.
External links
- Peters JR. "Endophthalmitis." eMedicine.com. Accessed September 28, 2006.
- Wu L. "Endophthalmitis, Fungal." eMedicine.com. Accessed September 28, 2006.