Endophthalmitis: Symptoms, Causes, Treatment

What are the symptoms of endophthalmitis?

Endophthalmitis is a serious inflammation of the interior of the eye, usually caused by an infection. The symptoms can vary depending on the severity and cause but typically include:

1. Severe Eye Pain: This is often one of the first symptoms and can be quite intense.
2. Redness of the Eye: The white part of the eye (sclera) may become very red.
3. Blurred or Decreased Vision: Vision may become cloudy or significantly reduced.
4. Swelling of the Eyelids: The eyelids may become swollen and puffy.
5. Sensitivity to Light (Photophobia): Bright lights may become extremely uncomfortable.
6. Discharge from the Eye: There may be pus or other discharge from the eye.
7. A Feeling of Something in the Eye: It can feel like there is a foreign object in the eye.
8. Floaters: Small specks or strings that drift into the field of vision.

If you suspect endophthalmitis, it is crucial to seek immediate medical attention, as prompt treatment is essential to prevent potential vision loss.

What are the causes of endophthalmitis?

Endophthalmitis is typically caused by an infection, which can be introduced into the eye through various means. The most common causes include:

1. Post-surgical Complications: Endophthalmitis can develop as a complication of eye surgery, such as cataract surgery or vitrectomy. Bacteria or fungi may enter the eye during the surgical procedure, leading to infection.
2. Trauma: Penetrating injuries to the eye can introduce infectious agents, such as bacteria or fungi, into the eye, causing endophthalmitis.
3. Systemic Infections: In some cases, bacteria or fungi from infections elsewhere in the body can spread to the eye through the bloodstream, leading to endophthalmitis.
4. Contaminated Injections: In rare cases, endophthalmitis can occur as a result of contaminated injections into the eye, such as intravitreal injections for the treatment of various eye conditions.
5. Endogenous Spread: In immunocompromised individuals, infections can spread from other parts of the body to the eye, causing endophthalmitis. This is less common but can occur in conditions such as bacterial endocarditis.

The specific causative organisms can vary but commonly include bacteria such as Staphylococcus aureus, Streptococcus species, and Pseudomonas aeruginosa, as well as fungi such as Candida species.

How is the diagnosis of endophthalmitis made?

Diagnosing endophthalmitis typically involves a combination of medical history, clinical examination, and diagnostic tests. Here’s how it’s typically done:

1. Medical History: The doctor will ask about any recent eye surgeries, trauma to the eye, or systemic infections that could potentially lead to endophthalmitis.
2. Clinical Examination: The eye will be examined for signs of inflammation, such as redness, swelling, and decreased vision. The doctor may use a slit lamp to examine the structures inside the eye in detail.
3. Visual Acuity Test: This test measures how well you can see at various distances. Changes in visual acuity may indicate the presence of endophthalmitis.
4. Intraocular Pressure Measurement: Increased intraocular pressure can be a sign of inflammation within the eye.
5. Microbiological Testing: If there is suspicion of infection, a sample of fluid from inside the eye (vitreous humor) may be collected and sent for microbiological testing to identify the causative organism.
6. Ultrasound Imaging: Ultrasound imaging of the eye can help visualize the internal structures and identify any abnormalities, such as vitreous opacities or retinal detachment, which are common findings in endophthalmitis.
7. Ocular Coherence Tomography (OCT): This imaging technique provides detailed cross-sectional images of the retina and can help identify signs of inflammation or retinal damage.
8. Fluorescein Angiography: This test involves injecting a dye into the bloodstream and taking photographs of the retina to assess blood flow and detect any leakage from blood vessels, which can be indicative of inflammation or infection.

Diagnosing endophthalmitis promptly is crucial for initiating appropriate treatment and minimizing the risk of vision loss. If you experience symptoms suggestive of endophthalmitis, it’s important to seek immediate medical attention from an eye care professional.

What is the treatment for endophthalmitis?

Treatment for endophthalmitis typically involves aggressive management with a combination of antibiotics, anti-inflammatory medications, and sometimes surgical intervention. The specific treatment approach may vary depending on the severity of the condition and the underlying cause. Here’s an overview of the treatment options:

1. Intravitreal Antibiotics: The mainstay of treatment for bacterial endophthalmitis involves injecting antibiotics directly into the vitreous cavity of the eye. Commonly used antibiotics include vancomycin and ceftazidime. The choice of antibiotic may be adjusted based on the suspected or identified causative organism.
2. Systemic Antibiotics: Oral or intravenous antibiotics may be used in addition to intravitreal antibiotics, especially in cases of suspected or confirmed systemic infection.
3. Corticosteroids: Topical or systemic corticosteroids may be used to reduce inflammation in the eye, but their use is controversial and must be carefully monitored due to the potential for worsening infection.
4. Vitrectomy: In severe cases or when there is a significant amount of inflammation or debris in the vitreous cavity, a vitrectomy may be performed. This surgical procedure involves removing the vitreous gel along with any infectious material and replacing it with a clear solution.
5. Supportive Therapy: Supportive measures such as pain management, eye patching, and lubrication may be used to alleviate symptoms and promote healing.

The goal of treatment is to eradicate the infection, control inflammation, and preserve vision. Early diagnosis and prompt initiation of treatment are crucial for a favorable outcome. It’s important to follow the treatment plan prescribed by your ophthalmologist and attend follow-up appointments to monitor progress and manage any complications.