Endophthalmitis is a rare but severe disease in ophthalmology. It is a complication that usually occurs after a trauma or ocular surgery or as a result of systemic infection. In this disease, the intraocular infection affects the inner coats of the eye, which is associated with significant, progressive vitreous inflammation.
This sight-threatening complication can result from the endogenous or exogenous spread of infecting organisms into the eye. In cases of exogenous endophthalmitis, the route of entry of infective organisms is through an external source, such as trauma, surgery or infected cornea. At the same time, endogenous endophthalmitis results from the hematogenous spread of microorganisms from distant foci.
Symptoms of endophthalmitis
The patients may experience decreased vision due to progressive inflammation. The other complications may include eyelid oedema, conjunctival injection, circumcorneal congestion, pain, photophobia, anterior chamber inflammation with hypopyon, absent red reflex, vitreous cells and haze.
Risk factors of Endophthalmitis
There are certain systemic risk factors for endophthalmitis. The risk factors include diabetes mellitus, recent hospitalization, urinary tract infection, immunosuppression, indwelling catheters and intravenous drug abuse(IVDA).
Diagnosis and treatment
An essential diagnostic finding is the presence of a white infiltrate originating in the choroid and sometimes erupting into the vitreous cavity.
- The B-scan ultrasound can be helpful in identifying vitreous or chorioretinal infiltrates if the posterior segment cannot be visualized.
- Several diagnostic tests such as blood tests, laboratory tests, imaging and ocular fluid can be helpful for occult infection.
- Vitreous fluid biopsy has a higher diagnostic yield and is preferable.
- In cases of fungal endophthalmitis, a serum called beta-glucan can be useful in detecting the presence of beta-D glucan found in the fungal walls of several species.
- Neuroimaging can be useful in evaluating intraocular foreign body and intraorbital or intracranial sources of infection.
Treatment of endophthalmitis should be initiated without any delay, even before a definitive diagnosis is made. The treatment should start with intravitreal antibiotic administration, with hospitalization and proper disease consultant under the top eye specialists in Kolkata. Systemic therapy with antibiotics and antifungals under close observation is preferable if the ocular lesion is confined to the choroid.
In some instances where the infection has spread beyond the choroid into the vitreous, more aggressive intravitreal antibiotic therapy is preferable.
The post-treatment complications from endophthalmitis can be controlled and reduced by following the advice of the opthalmologist. The prescribed eye drops or eye ointments should be taken timely. In cases where an eye patch is prescribed, it should be used appropriately. Follow up eye appointments should be kept with the opthalmologist.
Prevention of endophthalmitis
Endophthalmitis can be prevented by protecting the eye by wearing eyewear to prevent an object to fly into the eye. Protective eyewear may include eye shields, goggles or helmets. In case of any recent eye surgery, it is preferred to follow the doctor's post-operative instructions and reduce the risk for any kind of eye infection.
Endophthalmitis is a very complex eye condition that can potentially cause serious damage to vision. It may result in declining vision and some cases loss of an eye may occur. Although the disease can be easily prevented or significantly reduced if the condition is adequately treated. It is a complex medical emergency that requires appropriate medical treatment and attention. It properly treated and taken care of, the outlook of endophthalmitis is usually favourable.
