Definition

What is endophthalmitis?

Endophthalmitis is the term used to describe severe inflammation of the tissues inside the eye. The inflammation is typically due to infection by bacteria (eg. Staphylococcus species, Streptococcus species, Gram-negative bacteria) or fungi (eg. Candida, Aspergillus). It is rarely caused by viruses (herpes simplex or herpes zoster) or protozoa (eg. Toxocara, Toxoplasma). Sterile (non-infectious) endophthalmitis can develop as a reaction to lens fragments retained in the eye after cataract surgery or to drugs injected into the eye.

How common is endophthalmitis?

Endophthalmitis is rare, occurring in only 2-15% of all cases. Average annual incidence is about 5 per 10,000 hospitalized patients. In unilateral cases, the right eye is twice as likely to become infected as the left eye, probably because of its more proximal location to direct arterial blood flow from the right innominate artery to the right carotid artery.

However, it can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of endophthalmitis?

The most common symptoms are loss of vision and pain. Additional symptoms vary. They depend on what caused the eye infection:

  • Postoperative endophthalmitis.
  • The most common cause of this condition is a bacterial infection after cataract surgery. This serious problem can lead to permanent loss of vision.
  • Symptoms vary slightly. They depend on whether the infection occurs early (six weeks or less) or late (months or years) after surgery.
  • Early symptoms can include:
  • A dramatic decrease in vision in the affected eye;
  • Eye pain that worsens after surgery;
  • Red eyes;
  • Swollen eyelids;
  • Late symptoms tend to be milder than early symptoms. They may include:
  • Blurred vision;
  • Increased sensitivity to bright light;
  • Mild eye pain.

Posttraumatic endophthalmitis.

 Symptoms caused by a penetrating eye injury are generally dramatic:

  • A dramatic decrease in vision in the affected eye;
  • Eye pain that becomes worse.
  • Red eyes;
  • Swollen eyelids.
  • Hematogenous endophthalmitis.

 This is when an infection spreads through the bloodstream and settles in the eye. Symptoms may develop gradually and be fairly subtle. For example:

  • A mild decrease in vision over a period of a few weeks
  • The appearance of floaters. These are dark, semi-transparent, floating shapes in the field of vision.

When should I see my doctor?

Endophthalmitis is a medical emergency. It can cause permanent loss of vision if not diagnosed and treated promptly.

Call your doctor immediately if you If you have any signs or symptoms listed above or have any questions. This is particularly important if you have a history of:

  • Eye surgery;
  • Eye trauma;
  • Any condition that weakens your immune defenses.

Please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes endophthalmitis?

There are a great number of etiologies caused this condition:

  • Bacteria: N. meningitidis, Staphylococcus aureus, S. epidermidis, S. pneumoniae, other streptococcal spp., Propionibacterium acnes, Pseudomonas aeruginosa, other gram negative organisms.
  • Viruses: Herpes simplex virus.
  • Fungi: Candida spp. Fusarium
  • Parasites: Toxoplasma gondii, Toxocara.

Late onset endophthalmitis is mostly caused by Proprionobacterium acne.

Causative organisms are not present in all cases. Endophthalmitis can emerge by entirely sterile means, e.g. an allergic reaction to a drug administered intravitreally

Risk factors

 What increases my risk for endophthalmitis?

Some risk factors can rise up the rate of endophthalmitis, such as:

  • Eye trauma;
  • Eye surgery;
  • Intraocular injection;
  • Bloodstream infection.

Diagnosis &treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is endophthalmitis diagnosed?

Endophthalmitis can lead to serious vision problems. A medical doctor who specializes in eye problems (an ophthalmologist) must diagnose and treat it.

The doctor will review your symptoms. He or she will ask about your medical history, especially any eye surgery or eye trauma.

The doctor will examine your eyes. He or she will test how well you see in both eyes. The doctor will use an ophthalmoscope. This is a lighted instrument for looking inside the eye. An ultrasound of the eye may be ordered. Ultrasound can detect abnormal debris in the center of the eye.

The ophthalmologist may recommend a procedure called a vitreous tap. The doctor anesthetizes the eye. He or she then uses a tiny needle to withdraw some of the eye’s internal fluid. This fluid is tested for bacteria or other organisms.

How is endophthalmitis treated?

Treatment of this disease depends on:

  • What caused the endophthalmitis
  • The state of vision in the affected eye

When the condition is caused by a bacterial infection, options include one or more of the following:

  • Intravitreal antibiotics. Antibiotics are injected directly into the infected eye. Usually, some vitreous is removed to make room for the antibiotic.
  • Your doctor may inject corticosteroids into your eye. They will decrease inflammation and speed healing.
  • Intravenous antibiotics. Antibiotics may be injected into a vein. This may be prescribed for patients with severe infection.
  • Topical antibiotics. Antibiotics may be applied to the surface of the eye when there is a wound infection in addition to endophthalmitis.
  • Part of the eye’s infected vitreous fluid is removed. It is replaced with sterile saline or another compatible liquid. This usually is done if vision loss is so severe that the person is nearly blind.

When the condition is caused by a fungal infection, doctors usually inject an antifungal medication directly into the infected eye. The medication may also be given intravenously. Or, the person may receive an oral antifungal drug.

The ophthalmologist will monitor your progress. You will have frequent eye exams to monitor whether the treatment is improving your vision or not.

Lifestyle changes &home remedies

What are some lifestyle changes or home remedies that can help me manage endophthalmitis?

The following lifestyles and home remedies might help you cope with this condition:

  • If you have had cataract surgery, you can help to decrease your risk of infection. To do so, follow your doctor’s instructions for eye care after your surgery. Also, see your doctor regularly for follow-up eye exams.
  • To prevent endophthalmitis caused by eye trauma, use protective eyewear at work and during contact sports. Goggles, eye shields and helmets can help protect against industrial debris that can pierce or cut the eyes.
  • If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: January 4, 2017 | Last Modified: January 4, 2017

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