Endophthalmitis


Endophthalmitis

Description, Causes and Risk Factors:

Endophthalmitis is an ocular inflammation resulting from the introduction of an infectious agent into the posterior segment of the eye. During infection, irreversible damage to delicate photoreceptor cells of the retina frequently occurs. Despite aggressive therapeutic and surgical intervention, endophthalmitis generally results in partial or complete loss of vision, often within a few days of inoculation.

Endophthalmitis

Infectious agents generally gain access to the posterior segment of the eye following one of three routes:

    As a consequence of intraocular surgery (postoperative).

  • Following a penetrating injury of the globe (posttraumatic).

  • From hematogenous spread of bacteria to the eye from a distant anatomical site (endogenous).

Although uncommon, endophthalmitis can also result from keratitis, an infection of the cornea which, if left untreated, can result in corneal perforation and intraocular seeding of organisms.

Bacterial endophthalmitis is an infection of the interior of the eye that, despite appropriate therapeutic intervention, frequently results in visual loss. Recently, research has begun to elucidate the molecular and cellular events that contribute to the damage that occurs in intraocular infection.

Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis is infrequently reported in clinical studies. Five cases of acute post-cataract surgery endophthalmitis caused by S. lugdunensis were taken from a Multicenter prospective study conducted in four university-affiliated hospitals in France. These cases were characterized by severe ocular inflammation occurring with a mean delay of 7.6 days after cataract surgery, severe visual loss (hand motions or less in three cases), and dense infiltration of the vitreous. Each of these patients was initially treated by using a standard protocol with intravitreal (vancomycin and ceftazidime), systemic, and topical antibiotics. Given the severity of the endophthalmitis, even though bacteria were sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in four cases. The final visual prognosis was complicated by severe retinal detachment in three cases. The microbiological diagnosis was reached by using conventional cultures with specific biochemical tests and Eubacteriales PCR amplification followed by direct sequencing.

A more comprehensive understanding of the contributions of the molecular and cellular interactions in endophthalmitis will likely unveil possible therapeutic targets designed to ameliorate the infection and preserve vision.

Symptoms:

    Pain and redness.

  • Chemosis.

  • Corneal edema.

  • Frank hypopyon.

  • "String of pearls" in vitreous.

  • Filtering bleb.

  • Fibrin clot in the anterior chamber (AC).

  • Visual loss.

Diagnosis:

The most important laboratory study for endophthalmitis is Gram stain and culture of the aqueous and vitreous obtained by the ophthalmologist.

Other tests:

    CBC with differential.

  • Erythrocyte sedimentation rate.

  • Blood urea nitrogen (BUN) & creatinine.

Imaging:

    CT/MRI scan of the orbit may help to rule out other entities in the differential diagnosis.

  • Ocular ultrasound is helpful when positive findings are seen such as low amplitude mobile echoes, vitreous membranes, and thickening of retina and choroid; however, sensitivity is not high enough to rule out the diagnosis with a negative ultrasound.

  • Cardiac imaging to rule out endocarditis.

Treatment:

The treatment of this condition involves culturing a sample of the fluid from within the eye to determine the type of bacteria involved, combined with injecting antibiotics into the infected eye. Depending on the circumstances, oral antibiotics may also be utilized. Cases of severe infection may require surgery to help clear the bacteria and inflammation from the eye.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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