Endophthalmitis
Definition
Endophthalmitis is a severe, sight-threatening inflammation of the intraocular tissues, including the vitreous and/or aqueous humor. It is usually caused by an infection (bacterial or fungal) but can also occur due to non-infectious causes such as autoimmune reactions or retained surgical materials.
Types of Endophthalmitis
1. Infectious Endophthalmitis
Exogenous Endophthalmitis: Caused by an external source, often due to surgery, trauma, or eye injections.
Endogenous Endophthalmitis: Caused by an infection that spreads to the eye from another part of the body via the bloodstream.
2. Non-Infectious (Sterile) Endophthalmitis
Caused by autoimmune diseases, toxic reactions to intraocular substances (such as medications or surgical materials), or post-surgical inflammation.
Causes of Endophthalmitis
1. Infectious Causes
Bacterial: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa
Fungal: Candida albicans, Aspergillus species
Parasitic and Viral: Less common, but can be caused by herpes viruses or toxoplasmosis.
2. Non-Infectious Causes
- Post-surgical inflammation
- Autoimmune conditions
- Retained lens material after cataract surgery
Signs and Symptoms
- Severe eye pain
- Sudden loss of vision
- Redness and swelling of the eye
- Hypopyon (pus collection in the anterior chamber)
- Photophobia (light sensitivity)
- Blurred vision
- Eyelid swelling
Diagnosis
1. Clinical Examination
- Slit-lamp examination to assess inflammation
- Fundoscopy to check for vitreous opacities
2. Laboratory Tests
- Aqueous and Vitreous Tap: Culture and sensitivity testing
- Blood Culture: To check for systemic infection
- Polymerase Chain Reaction (PCR): For rapid bacterial/fungal identification
3. Imaging
- Ultrasound B-scan: Useful if the retina is obscured by vitreous opacities
Investigation
- Complete Blood Count (CBC): To check for systemic infection
- Erythrocyte Sedimentation Rate (ESR) & C-Reactive Protein (CRP): Markers of inflammation
- Fungal Staining and Cultures: If fungal infection is suspected
Treatment of Endophthalmitis
1. Intravitreal Antibiotics (First-Line Treatment)
Bacterial Endophthalmitis:
- Vancomycin (1 mg/0.1 mL) + Ceftazidime (2.25 mg/0.1 mL)
- Alternative: Amikacin (0.4 mg/0.1 mL)
Fungal Endophthalmitis:
- Intravitreal Amphotericin B (5-10 µg/0.1 mL)
- Alternative: Voriconazole (100 µg/0.1 mL)
2. Systemic Antibiotics (If Needed)
- If infection is suspected to be systemic (Endogenous Endophthalmitis)
- Vancomycin (IV 1g q12h) + Ceftazidime (IV 2g q8h)
- For fungal cases: Oral Fluconazole or Voriconazole
3. Anti-Inflammatory Agents
- Intravitreal Dexamethasone (0.4 mg/0.1 mL) (Reduces inflammation)
- Systemic Steroids (Oral Prednisolone 1 mg/kg/day) (Only after antibiotics)
4. Vitrectomy (If Severe Infection)
Early Vitrectomy is done in severe cases to remove infected vitreous and improve drug penetration.
Medicines Should NOT Be Given
- Systemic Steroids Alone: Can worsen bacterial infections
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) Alone: Do not treat infection and can mask symptoms
- Unprescribed Antibiotics: Can lead to resistance
Role of Vitamins in Recovery
1. Vitamin A
Supports eye health and helps in epithelial healing
2. Vitamin C & E
Have antioxidant properties that reduce oxidative stress in ocular tissues
3. Vitamin D
Modulates immune responses and reduces inflammation
4. Vitamin B Complex
Helps in nerve regeneration and recovery of vision
Lifestyle Effects of Endophthalmitis
- Loss of vision: Can lead to permanent blindness if untreated
- Emotional Impact: Anxiety, depression due to visual impairment
- Work Limitations: Difficulty in reading, driving, or working
- Frequent Hospital Visits: Need for long-term follow-ups
Complications of Endophthalmitis
- Permanent Vision Loss
- Retinal Detachment
- Glaucoma (Increased Eye Pressure)
- Corneal Opacity
- Phthisis Bulbi (Shrunken, Non-Functional Eye)
Management & Prevention
1. Prevention
- Proper Sterilization During Surgery
- Post-Surgical Antibiotics (Moxifloxacin or Ciprofloxacin Drops)
- Diabetic Control (as diabetes increases risk of infections)
- Early Treatment of Any Eye Infection
2. Long-Term Management
- Regular Eye Exams
- Low-Vision Aids (Magnifiers, special glasses)
- Psychological Support (Counseling for vision loss)
Conclusion
Endophthalmitis is a medical emergency that requires immediate attention. Early diagnosis and aggressive treatment with intravitreal antibiotics or antifungals, along with possible vitrectomy, can help preserve vision. Preventive measures like maintaining hygiene during eye surgeries and prompt treatment of infections can reduce the risk of endophthalmitis.