Endophthalmitis
| Endophthalmitis | |
|---|---|
| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | H44.0-H44.1 |
| ICD-9-CM | 360.0-360.1 |
| DiseasesDB | 30828 |
| MedlinePlus | 001626 |
| eMedicine | emerg/880 oph/393 oph/394 oph/706 |
| Patient UK | Endophthalmitis |
| MeSH | D009877 |
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.
Contents
Signs and symptoms
In cases of endophthalmitis, one usually finds a history of recent intraocular surgery or penetrating ocular trauma. In some cases of endogenous 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. 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.
Causative organisms
- Bacteria: N. meningitidis, Staphylococcus aureus, S. epidermidis, S. pneumoniae, other streptococcal spp., Pseudomonas aeruginosa, other gram negative organisms.[1]
- Viruses: Herpes simplex virus.[1]
- Fungi: Candida spp.[1]
- Parasites: Toxoplasma gondii, Toxocara.[1]
Late onset endophthalmitis is mostly caused by Proprionobacterium acne.[2]
Complications
- Panophthalmitis — Progression to involve all the coats of the eye.[3]
- Corneal ulcer[3]
- Orbital cellulitis[3]
- no light perception vision[3]
Treatment
The patient needs urgent examination by an ophthalmologist preferably a vitreo-retina specialist who will usually decide for urgent intervention to provide intravitreal injection of potent antibiotics and also prepare for an urgent surgery (pars plana vitrectomy) as needed. Enucleation may be required to remove a severe and intractable infection resulting in blind and painful eye.
Prevention
A Cochrane Review sought to evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery.[4] Separate studies from the research showed that a periocular injection of penicillin with chloramphenicol-suphadimidine eye drops,[5] and an intracameral cefuroxime injection with topical levofloxacin[6] resulted in a risk reduction of developing endophthalmitis following cataract surgery for subjects.
References
- ↑ 1.0 1.1 1.2 1.3 Forbes BA, Sahm DF, Weissfeld AS. Bailey & Scott's Diagnostic Microbiology. 12th Edition. Mosby Elsevier, 2007. p. 834.
- ↑ http://www.retinalphysician.com/articleviewer.aspx?articleID=107123
- ↑ 3.0 3.1 3.2 3.3 Lua error in package.lua at line 80: module 'strict' not found.
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