Endophthalmitis is a severe inflammation of the interior of the eye, usually caused by an
infection. This condition is considered a medical emergency and requires prompt diagnosis and treatment to prevent vision loss or even blindness. Here, we explore key aspects of endophthalmitis in the context of infectious diseases, addressing crucial questions about its causes, symptoms, diagnosis, and treatment.
What Causes Endophthalmitis?
Endophthalmitis can be classified into two main types based on its origin: exogenous and endogenous. Exogenous Endophthalmitis: This is the most common form and occurs when
microorganisms enter the eye from an external source. It is often associated with ocular surgery, particularly cataract surgery, trauma, or an eye injection.
Endogenous Endophthalmitis: This type is less common and results from the spread of infection from another part of the body through the bloodstream. Conditions like
bacteremia or fungemia often lead to endogenous endophthalmitis.
Severe pain in the affected eye
Decreased vision or
vision loss Redness of the eye
Swelling around the eye
Pus or discharge from the eye
Photophobia (sensitivity to light)
These symptoms necessitate immediate medical attention. Delay in diagnosis and treatment can lead to irreversible damage to the eye structures.
How Is Endophthalmitis Diagnosed?
Diagnosis of endophthalmitis involves a combination of clinical examination and laboratory tests: Clinical Examination: An ophthalmologist will perform a thorough examination using a slit-lamp microscope to assess the anterior segment of the eye. Intraocular pressure may also be measured.
Imaging: Ultrasound of the eye can help visualize the extent of the infection and any involvement of the retina or posterior segment.
Microbiological Tests: A sample of aqueous humor or vitreous humor is obtained via
vitreous tap or biopsy. This sample is then cultured to identify the causative organism and determine its sensitivity to antibiotics.
What Are the Common Pathogens?
The pathogens responsible for endophthalmitis vary depending on whether the infection is exogenous or endogenous: Exogenous Infections: The most common organisms include Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus species. Gram-negative bacteria are less common but can be involved.
Endogenous Infections: These are often caused by
fungal organisms like Candida species, especially in immunocompromised patients. Bacterial causes include Streptococcus, Staphylococcus, and Enterococcus species.
Antibiotic Therapy: Intravitreal injection of antibiotics is the cornerstone of treatment for bacterial endophthalmitis. Commonly used antibiotics include vancomycin and ceftazidime. Systemic antibiotics may also be administered depending on the severity of the infection.
Antifungal Therapy: For fungal endophthalmitis, antifungal agents like
amphotericin B or voriconazole are used.
Surgical Intervention: Vitrectomy, the surgical removal of the vitreous gel from the eye, may be necessary in severe cases to remove infectious material and improve antibiotic penetration.
Supportive Care: This includes managing pain and inflammation with corticosteroids, though their use must be carefully monitored to avoid exacerbating the infection.
What Are the Prognosis and Prevention Strategies?
The prognosis for endophthalmitis varies based on the promptness of treatment and the organism involved. Early diagnosis and treatment often result in better visual outcomes. However, some cases can lead to significant vision loss despite aggressive treatment.
Prevention strategies are vital, especially in surgical settings, and include: Strict adherence to aseptic techniques during ocular surgeries and procedures
Prophylactic use of antibiotics in high-risk surgeries
Prompt treatment of systemic infections to prevent endogenous spread
Endophthalmitis remains a challenging condition in the field of infectious diseases. Awareness, early detection, and rapid intervention are key to managing this potentially sight-threatening infection effectively.
