Endophthalmitis refers to a severe inflammation of the interior of the eye, a condition that demands immediate medical attention. This rare but serious infection can rapidly lead to significant vision loss if not addressed promptly.
What is Endophthalmitis?
Endophthalmitis involves inflammation or infection within the eye’s internal structures, including the vitreous and aqueous humor. This condition typically arises from external or internal sources, categorizing it into distinct forms. Exogenous endophthalmitis represents the most common type, originating from an external pathogen. It frequently occurs following eye surgeries, such as cataract removal, or after injections administered directly into the eye, or penetrating eye injuries.
The causative agents in exogenous cases often enter the eye directly through a surgical incision or a wound. In contrast, endogenous endophthalmitis develops when an infection spreads to the eye from another part of the body. Infectious agents travel through the bloodstream to reach the eye.
Common infectious agents responsible for endophthalmitis include various bacteria and fungi. Bacterial pathogens like Staphylococcus epidermidis and Pseudomonas aeruginosa are frequently identified in post-surgical cases. Fungal species, such as Candida species, can also cause endophthalmitis, particularly in individuals with weakened immune systems or those with systemic fungal infections. These microorganisms colonize the eye’s internal environment, leading to a destructive inflammatory response.
Recognizing the Signs
Individuals developing endophthalmitis often experience a rapid onset of noticeable symptoms. Severe pain in the affected eye is a common complaint, often accompanied by a sudden and significant decrease in vision. The eye typically appears noticeably red, and the eyelids may become swollen.
Sensitivity to light, known as photophobia, can also develop, making it uncomfortable to be in brightly lit environments. In some cases, a visible collection of pus may form in the front chamber of the eye, a condition referred to as hypopyon. These symptoms, especially following any eye surgery or a recent eye injury, necessitate immediate medical evaluation.
Diagnosis and Treatment
Ophthalmologists employ a combination of clinical assessments and laboratory tests to diagnose endophthalmitis. A thorough clinical examination, often involving slit-lamp biomicroscopy and a dilated fundus exam, allows the doctor to visualize the internal structures of the eye. Ocular ultrasound may also be performed to assess the extent of inflammation. A definitive diagnosis often relies on sampling the eye’s fluids, typically through a vitreous tap or biopsy, where a small amount of the vitreous gel is carefully withdrawn.
These fluid samples are then sent to a laboratory for analysis, including bacterial and fungal cultures, and sometimes polymerase chain reaction (PCR) testing. Identifying the specific causative organism guides the targeted treatment approach. Treatment for endophthalmitis typically begins with intravitreal injections, which involve directly injecting antibiotics, such as vancomycin and ceftazidime, or antifungals into the eye. These direct injections deliver high concentrations of medication to the infection site.
In more severe cases, or if initial injections are insufficient, a surgical procedure called vitrectomy may be performed. This involves the removal of the infected vitreous gel from the eye, which can help reduce the bacterial or fungal load and remove inflammatory debris. Systemic medications, including oral or intravenous antibiotics or antifungals, may also be prescribed, particularly for endogenous infections or widespread severe cases. Additionally, corticosteroids may be administered to help reduce the inflammation that accompanies the infection.
Outlook and Prevention
The visual outcome for individuals with endophthalmitis varies widely, influenced by factors such as the cause of the infection, its severity, and the promptness of treatment. Early diagnosis combined with aggressive therapeutic interventions improves the chances of preserving vision. Despite optimal treatment, some individuals may still experience a degree of permanent vision loss.
Preventative measures are important in reducing the incidence of endophthalmitis. Strict adherence to sterile techniques during all eye surgeries and injections into the eye is an essential practice. Prophylactic antibiotics, given either during or immediately after eye procedures, also play a role in preventing infection. Proper wound care following any eye injury is also important to prevent pathogens from entering the eye. Furthermore, prompt and effective treatment of systemic infections can help prevent the endogenous spread of infection to the eye.