chronic endophthalmitis

Chronic Endophthalmitis: A Rare but Serious Eye Condition

Chronic endophthalmitis is a long-term, low-grade inflammation of the eye that can be caused by various factors, including foreign bodies or retained intraocular lens fragments. This condition is typically characterized by a gradual onset and persistence over an extended period.

Causes and Symptoms

• Chronic endophthalmitis may develop gradually over time due to the entry of certain types of bacteria or fungi into the eye.
• The symptoms of chronic endophthalmitis can be mild and may not always be immediately apparent, making it challenging to diagnose.
• Common symptoms include:
  • Inflammation of the white of the eye
  • White or yellow discharge on or inside the eyelid
  • Corneal cloudiness
  • Decreased vision

Types of Endophthalmitis

There are two main types of endophthalmitis: acute and chronic. Acute endophthalmitis presents with sudden and severe symptoms, whereas chronic endophthalmitis develops gradually over time.

• Acute Endophthalmitis: This type is caused by the entry of bacteria or fungi into the eye, often as a result of an injury or surgery.
• Chronic Endophthalmitis: This type is characterized by a gradual onset and persistence over an extended period, often due to the presence of foreign bodies or retained intraocular lens fragments.

Complications and Treatment

If left untreated, chronic endophthalmitis can lead to severe complications, including:

• Permanent vision loss
• Eye pain
• Redness in the white of the eye

Treatment for chronic endophthalmitis typically involves antibiotics or antifungal medications to address the underlying infection. In some cases, surgical intervention may be necessary to remove foreign bodies or repair damaged tissue.

References

• [3] Puncture wounds to the eye are the most likely cause of endophthalmitis.
• [11] Chronic endophthalmitis is a long-term, low-grade inflammation of the eye that is typically caused by a foreign body or a retained intraocular lens fragment.
• [15] Chronic cases that occur outside of the 6-week window are often related to a previous surgery and are commonly caused by slowly progressive infections such as Propionibacterium acnes or fungus.

Chronic Endophthalmitis Signs and Symptoms

Chronic endophthalmitis is a long-term, low-grade inflammation of the eye that can cause various symptoms. The signs and symptoms of chronic endophthalmitis may be subtle and develop gradually over time.

• Vision Loss: One of the most common symptoms of chronic endophthalmitis is vision loss or blurry vision [10].
• Eye Pain: Chronic endophthalmitis can cause eye pain, although it may not be as severe as in acute cases [6].
• Redness and Swelling: The eye may appear red and swollen due to inflammation [8].
• Light Sensitivity: People with chronic endophthalmitis may experience light sensitivity or photophobia [8].
• Discharge: A white or yellow discharge may be present on the eyelid or inside the eye [12].

Causes of Chronic Endophthalmitis

Chronic endophthalmitis is often caused by a foreign body or a retained intraocular lens fragment. Unlike acute endophthalmitis, which presents with sudden and severe symptoms, chronic endophthalmitis may develop gradually over time and persist for an extended period [10].

Important Note

Chronic endophthalmitis is a serious condition that requires prompt medical attention to prevent permanent vision loss. If you experience any of these symptoms, seek immediate medical help.

References: [8] - Symptoms include blurry vision/vision loss, light sensitivity, eye pain and swelling around the eye ... [10] Chronic endophthalmitis is a long-term, low-grade inflammation of the eye that is typically caused by a foreign body or a retained intraocular lens fragment. [12] Endophthalmitis causes the white of the eye to be inflamed. There may be a white or yellow discharge on or inside the eyelid, and the cornea may show a white cloudiness.

Chronic endophthalmitis diagnosis may require a detailed patient history, imaging studies, and microbiological testing. The following diagnostic tests are commonly used to diagnose chronic endophthalmitis:

• Imaging studies: Ultrasound or optical coherence tomography (OCT) can provide valuable insights into the extent of inflammation and damage to the eye.
• Microbiological testing: Cultures of samples from the eye, blood, and urine cultures may be performed to identify the causative organism.
• Visual acuity testing: To assess the patient's visual function and monitor any changes over time.
• Slit-lamp examination: A detailed examination of the anterior segment of the eye to look for signs of inflammation or damage.

In addition to these tests, a thorough history and physical examination are essential first steps in diagnosing chronic endophthalmitis. The patient's medical history, including any previous surgeries or infections, should be carefully reviewed.

It is worth noting that the diagnosis of chronic endophthalmitis may also involve other diagnostic tests such as:

• Erythrocyte sedimentation rate (ESR): To evaluate for rheumatic causes, chronic infections, or malignancy.
• Chronic postoperative endophthalmitis: May be associated with cataract surgery and requires a detailed patient history, imaging studies, and microbiological testing.

These tests are used to confirm the diagnosis of chronic endophthalmitis and to identify any underlying conditions that may have contributed to the development of this condition. [1][2][

Treatment Options for Chronic Endophthalmitis

Chronic endophthalmitis is a serious medical condition that requires prompt and effective treatment to prevent vision loss and other complications. While there are various treatment options available, the most common approach involves the use of intravitreal antibiotics and antifungals.

• Intravitreal Antibiotics: The primary treatment for chronic endophthalmitis often includes the injection of antibiotics directly into the vitreous gel in the eye. This is typically done using a pars plana vitrectomy, which involves removing the vitreous gel and replacing it with a saline solution. Vancomycin and amphotericin are commonly used intravitreal antibiotics for this purpose [4][9].
• Intravitreal Antifungals: In cases where fungal endophthalmitis is suspected or confirmed, antifungal medications such as voriconazole may be used in conjunction with antibiotics. The goal of treatment is to eliminate the infection and prevent further complications.
• Systemic Antimicrobials: In some cases, systemic antimicrobial therapy may also be necessary to treat endophthalmitis. This can involve administering antibiotics or antifungals intravenously or orally [14].

Important Considerations

When treating chronic endophthalmitis, it is essential to ensure the proper dosage of medications to avoid treatment failure or toxic effects on the retina. Additionally, the etiology of postoperative endophthalmitis may vary depending on the region and underlying factors.

• Proper Dosage: It is crucial to ensure that the correct dosage of antibiotics and antifungals is administered to prevent treatment failure [10].
• Etiology: The cause of endophthalmitis can vary, with different pathogens being more common in specific regions or cases [11].

Recent Developments

Research has also explored the potential use of fourth-generation fluoroquinolones, such as moxifloxacin, for prophylaxis and treatment of endophthalmitis. Studies have demonstrated its safety and efficacy in this context [12][13].

Chronic endophthalmitis is a rare but serious condition that can cause inflammation and damage to the eye. When diagnosing chronic endophthalmitis, it's essential to consider various differential diagnoses to ensure accurate treatment.

Possible Differential Diagnoses:

• Post-surgical Endophthalmitis: This type of endophthalmitis occurs after intraocular surgery and can be caused by retained lens fragments or other surgical materials.
• Toxic Anterior Segment Syndrome (TASS): TASS is an acute inflammatory condition that presents within 24 hours of surgery, but it can also mimic chronic endophthalmitis in some cases.
• Chronic Uveitis: Certain cases of chronic indolent endophthalmitis may be confused with chronic panuveitis or other forms of uveitis.
• Retained Intraocular Foreign Body: A retained intraocular foreign body can cause chronic inflammation and mimic the symptoms of endophthalmitis.
• Old Vitreous Hemorrhage: Chronic long-standing vitreous hemorrhage may have an appearance similar to endophthalmitis when the hemorrhage becomes white-gray color after degenerative changes in the hemoglobin content.

Other Considerations:

• Lens-induced Uveitis: This condition can be caused by retained cortical material or other lens-related issues.
• Intraocular Foreign Body: A foreign body in the eye can cause chronic inflammation and mimic endophthalmitis symptoms.
• Chronic Postoperative Inflammation: Persistent postoperative inflammation beyond 6 weeks may require further investigation to rule out endophthalmitis.

Key Takeaways:

• Accurate diagnosis of chronic endophthalmitis requires consideration of various differential diagnoses.
• Post-surgical complications, such as retained lens fragments or TASS, can mimic the symptoms of endophthalmitis.
• Other conditions like chronic uveitis, old vitreous hemorrhage, and intraocular foreign body should also be ruled out.

References:

[1] (8) CPE differential diagnosis spectrum includes noninfectious causes such as lens-induced uveitis secondary to retained cortical material, IOL-related complications, etc. [2] (11) Chronic long-standing vitreous hemorrhage may have an appearance similar to endophthalmitis when the hemorrhage becomes white-gray color after degenerative changes in the hemoglobin content. [3] (12) The differential diagnosis included infectious endophthalmitis caused by fungi or by P. acnes vs a lens-material–induced chronic inflammation. [4] (13) Chronic postoperative endophthalmitis presents more than 6 weeks following intra-ocular surgery and may be associated with cataract surgery, etc. [5] (15) Endophthalmitis is a clinical diagnosis, confirmed with subsequent laboratory testing.