Endophthalmitis: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

It is a bacterial or fungal infection within the eye that affects the vitreous and / or aqueous fluids.

Acute bacterial endophthalmitis is a condition that endangers vision and should be treated immediately as an emergency.

The clinical outcome depends both on the virulence of the infecting organism and on the speed with which the appropriate therapy is initiated.

If not treated right away, it can lead to blindness and eye loss.

Endophthalmitis is an infrequent complication of ocular surgery: most of the time, cataract surgery and ocular injections.

Great care must be taken during any eye surgery or procedure to maintain sterility and avoid infection.

Causes

There are two ways to get endophthalmitis.

Exogenous endophthalmitis

It is the most common form and occurs after perforation of the eyeball due to trauma, surgery or dissemination of an external ocular infection.

Sometimes, fragments of the lens that remain in the eye after cataract surgery can cause a certain type of endophthalmitis.

In addition, drugs that are injected into the vitreous cavity of the eye can carry infectious agents, whether they are contained in a contaminated medicine or through the act of penetrating the eye with a needle, which is quite delicate because of its wateriness.

Penetrating trauma to the eye can also introduce bacteria into the inner cavity of the eye, causing endophthalmitis.

Acute cases of endophthalmitis are caused by gram-positive bacteria, and to a lesser degree by gram-negative bacteria and present symptoms within 6 weeks after surgery or ocular trauma.

Chronic cases that show symptoms after 6 weeks are often related to previous surgery and are commonly caused by slowly progressive infections such as “Propionibacterium acnes” or fungi.

Endogenous endophthalmitis

It occurs when infectious organisms invade the inside of the eye from the bloodstream.

Systemic infections, which are those caused by some type of microorganism and that can spread to the eye causing endogenous endophthalmitis, are often associated with systemic fungal or gram-negative bacterial infections.

symptom

Symptoms of endophthalmitis occur rapidly, including progressive deterioration of vision, sensitivity to light, pain and swelling around the eye.

There may be a white or yellow discharge on or inside the eyelid, and the cornea may show a white cloudiness, due to the presence of a layer of white blood cells present in the anterior chamber of the eye between the iris and the cornea.

If there is a loss of vision after eye surgery, especially accompanied by pain, a doctor should be notified immediately.

Endophthalmitis usually occurs between 2 and 5 days after surgery, but some mild forms may occur weeks after surgery.

Patients who have undergone a glaucoma “filtration” procedure have an increased risk of developing endophthalmitis throughout life.

Endophthalmitis is usually a very serious problem and a quick examination by an ophthalmologist is essential to make an adequate diagnosis and initiate the treatment to follow.

Risk factors of endophthalmitis

The loss of vitreous gel (also called vitreous humor), altered posterior capsule, poor wound closure and prolonged surgery are risk factors for developing endophthalmitis.

Risk factors for endophthalmitis after trauma include:

  • Retained intraocular foreign body (with foreign material in the eye after an injury).
  • Surgery delayed for more than 24 hours to repair a serious injury (Not done immediately).
  • Hygiene conditions of the environment.
  • Damage to the lens during a trauma.

Diagnosis

Early diagnosis of endophthalmitis is essential. To determine which organism has caused the infection, it is necessary to perform a biopsy of the fluid inside your eye.

This fluid is sent to the laboratory for the determination of the pathogen, which will allow decisions to be made about the appropriate treatment.

Treatment

Once endophthalmitis is diagnosed, treatment is urgent and usually consists of a mixture of potent oral and intraocular antibiotics and anti-inflammatory medications and, sometimes, vitrectomy surgery.

The prognosis of endophthalmitis varies widely according to the cause of the infection, the severity and the amount of damage caused to the eye by inflammation and scarring.

Mild cases can have excellent visual results.

Severe cases can result not only with loss of sight, but also with the loss of the entire eye.