endophthalmitis

Endophthalmitis: A Serious Eye Infection

Endophthalmitis is a severe and potentially sight-threatening infection that affects the internal structures of the eye, including the aqueous and vitreous humors. This condition can be caused by bacteria or fungi, leading to inflammation and damage within the eyeball.

Causes and Types

• Bacterial endophthalmitis: Most often resulting from bacterial infection, this type is an acute panuveitis that affects the entire uvea.
• Fungal endophthalmitis: A less common type caused by fungal organisms.
• Endogenous endophthalmitis (EE): An uncommon intraocular infection with potentially devastating visual consequences.

Symptoms

The symptoms of endophthalmitis can be severe and include: * Severe eye pain * Redness in the white of the eye * Extreme sensitivity to bright light * Decreased vision

Diagnosis and Treatment

Diagnosing endophthalmitis involves various procedures, including anterior chamber tap and vitreous biopsy. Treatment options may include antibiotics or antifungal medications, depending on the cause of the infection.

Complications and Prevention

Endophthalmitis is a serious complication that can occur after cataract surgery. It's essential for ophthalmic surgeons and patients to take preventive measures to avoid this condition.

References: * [1] Endophthalmitis is an inflammatory reaction of the intraocular fluids or tissues caused by microbial organisms. (Source: 4) * Bacterial endophthalmitis is an acute panuveitis resulting most often from bacterial infection. (Source: 2) * Symptoms of Endophthalmitis may be severe and include severe eye pain, redness in the white of the eye, extreme sensitivity to bright light, and decreased vision. (Source: 3) * Endogenous endophthalmitis (EE) is an uncommon intraocular infection with potentially devastating visual consequences. (Source: 6) * Predominant symptoms include decreased vision and pain while inability to visualize the fundus, pupillary fibrin membrane, and hypopyon are the most common findings. (Source: 7) * Endophthalmitis describes inflammation within the eyeball, usually involving the vitreous cavity and aqueous humor in the anterior chamber. (Source: 8)

Endophthalmitis Signs and Symptoms

Endophthalmitis is a serious eye infection that can cause severe symptoms, potentially leading to permanent vision loss or even blindness. The following are the common signs and symptoms of endophthalmitis:

• Eye Pain: Severe eye pain that worsens over time, often accompanied by redness in the white of the eye [1][2]
• Red Eyes: Redness and inflammation in the affected eye, which can be a sign of infection [3][4]
• Decreased Vision: Sudden decrease or loss of vision in the affected eye, which can range from mild to severe [5][6]
• Light Sensitivity: Extreme sensitivity to bright light, making it difficult to look at lights or perform daily activities [7]
• Swollen Eyelids: Swelling and redness around the eyelid, which can be a sign of infection spreading to other areas [8]
• Discharge: Yellow or white discharge from the eye, which can be a sign of infection [9]

Complications

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

• Permanent Vision Loss: Permanent loss of vision in one or both eyes
• Enucleation: In some cases, patients may require enucleation (removal of the affected eye) due to severe infection and potential blindness [8]

It is essential to seek immediate medical attention if you experience any of these symptoms, as prompt treatment can help prevent long-term damage and vision loss.

References:

[1] Context result 1: "eye pain that keeps getting worse after surgery, an injection or injury to the eye" [2] Context result 3: "Intense eye pain that worsens with time" [3] Context result 4: "The white of the eye is inflamed." [5] Context result 5: "rapidly progressive, including pain, red eye, ocular discharge, and worsening vision;" [6] Context result 6: "Symptoms include blurry vision/vision loss, light sensitivity, eye pain and swelling around the eye." [7] Context result 7: "A dramatic decrease in vision in the affected eye" [8] Context result 8: "Decreased vision and permanent loss of vision are common complications of endophthalmitis. Patients may require enucleation..." [9] Context result 9: "worsening, cloudy vision; eye pain; redness and swelling in the eye;"

Diagnostic Tests for Endophthalmitis

Endophthalmitis, a potentially devastating intraocular infection, requires prompt and accurate diagnosis to initiate effective treatment. The following diagnostic tests are commonly used to diagnose endophthalmitis:

• Complete Blood Count with Differential: Evaluating for signs of infection, such as an elevated white count and left shift, can help identify the presence of endophthalmitis [2].
• Erythrocyte Sedimentation Rate (ESR): This test measures the rate at which red blood cells settle in a test tube, with higher rates indicating inflammation and potential infection [2].
• Eye Examination: A complete eye exam is necessary to diagnose endophthalmitis, including visual acuity testing, slit-lamp examination, and assessment of periocular pain [3][7].
• Ultrasound: This imaging technique can help identify intraocular abnormalities, such as retinal detachment or vitreous hemorrhage, which may be associated with endophthalmitis [7].
• Culture of Intraocular Fluids: Collecting and culturing fluid from the eye can help identify causative microorganisms and guide antibiotic treatment [5][8].
• Conjunctival Sampling: While conjunctival samples typically have no diagnostic value, collecting surface and intraocular samples can be useful in certain cases [8].

Additional Diagnostic Tools

Recent advances in diagnostic technology have led to the development of new tools for diagnosing endophthalmitis. These include:

• Molecular Diagnostics: Techniques such as PCR (polymerase chain reaction) can help identify specific microorganisms and guide treatment [9].
• Imaging Studies: Advanced imaging techniques, such as OCT (optical coherence tomography), can provide detailed images of the eye and aid in diagnosis [7].

References

[1] Jun 1, 2016 — Diagnostic workup and management options for this potentially devastating intraocular infection. [2] Jun 19, 2023 — Complete blood count with differential - Evaluating for signs of infection, elevated white count, left shift · Erythrocyte sedimentation rate - ... [3] They'll give you a complete eye exam. They'll take a sample of fluid or discharge from your eye to test in a laboratory. They may also want to test samples of ... [4] by WJ Ma · 2011 · Cited by 9 — A diagnosis of infectious endophthalmitis was made on the basis of clinical features, including periocular pain, loss of visual acuity, diffuse bulbar ... [5] 23 hours ago — The diagnosis of endophthalmitis relies on clinical findings. It is crucial to identify causative microorganisms in time for subsequent ... [6] by S Kamjoo — ' Differential Diagnosis of Acute Endophthalmitis ... Recent invasive medical procedures: extensive gastrointestinal surgery, endoscopy, dental ... [7] A complete eye examination is necessary to diagnose endophthalmitis. Additional testing, such as ultrasound, culture of intraocular fluids, and laboratory ... [8] Conjunctival samples usually have no diagnostic value because they typically represent patients' commensal flora. However, collecting surface and intraocular ... [9] by MA Sadiq · 2015 · Cited by 203 — This diagnostic tool promises to be useful in the management of patients with endophthalmitis, especially in samples that are culture negative ...

Treatment Options for Endophthalmitis

Endophthalmitis, an inflammation of the interior of the eye usually caused by infection, can be treated with various medications to help manage symptoms and prevent further complications.

• Antibiotics: Eye care providers may prescribe antibiotic or antifungal medications to treat bacterial or fungal endophthalmitis. These medications can be administered through eye drops, injections, or systemic treatment (1).
• Corticosteroids: Corticosteroids may also be prescribed to reduce inflammation and swelling in the affected eye (1).
• Vitrectomy: In some cases, a surgical procedure called vitrectomy may be performed to remove infected vitreous gel from the eye. This can help prevent further complications and promote healing.
• Intravitreal injections: Directly injecting antibiotics into the globe affords highest concentration of medication in the affected area (8).
• Systemic antifungal therapy: For immunocompromised patients, systemic antifungal therapy such as amphotericin or voriconazole may be recommended to treat fungal endophthalmitis (6).

Specific Medications

Some specific medications that are commonly used to treat endophthalmitis include:

• Vancomycin: A type of antibiotic that is often used to treat bacterial endophthalmitis (4).
• Ceftazidime: Another antibiotic that may be prescribed to treat bacterial endophthalmitis (4).
• Voriconazole: An antifungal medication that is considered the drug of choice for treating Aspergillus-related endophthalmitis (2).

References

(1) [1] - An eye care provider may treat endophthalmitis with medicine. They may prescribe antibiotic or antifungal medications or corticosteroids. (2) [2] - For Aspergillus, voriconazole is the drug of choice; it has adequate intraocular penetration when used systemically and can be administered ... (4) [4] - As stated earlier, current treatment regimens for bacterial endophthalmitis include direct intravitreal injections of vancomycin (1.0 mg/0.1 ml) and ceftazidime ... (6) [6] - Treatment in immunocompromised patients includes systemic antifungal therapy (e.g., amphotericin or voriconazole). (8) [8] - Initial treatment of post-traumatic endophthalmitis includes intravitreal antibiotic injection.

Differential Diagnosis of Endophthalmitis

Endophthalmitis is a serious and potentially sight-threatening condition that requires prompt diagnosis and treatment. The differential diagnosis of endophthalmitis involves considering various conditions that can present with similar symptoms.

Noninfectious Causes:

• Toxic Anterior/Posterior Segment Syndrome (TASS): This is a rare but serious condition that can occur after cataract surgery, characterized by inflammation and damage to the anterior and posterior segments of the eye. [5]
• Phacoantigenic Uveitis: This is an inflammatory condition that can occur in response to antigens released during cataract surgery. [8]

Infectious Causes:

• Bacterial Endophthalmitis: This is a vision-threatening condition caused by bacterial infection, which must be managed as an emergency. [10]
• Fungal Endophthalmitis: This is a rare but serious condition caused by fungal infection, which can occur after cataract surgery or trauma to the eye.
• Viral Endophthalmitis: This is a rare condition caused by viral infection, such as cytomegalovirus.

Other Conditions:

• Acute Retinal Necrosis: This is a rare but serious condition characterized by inflammation and necrosis of the retina.
• Toxoplasmosis: This is an infectious condition caused by the parasite Toxoplasma gondii, which can affect the eye.
• Syphilis: This is a sexually transmitted infection that can cause endophthalmitis in rare cases.
• Tuberculosis: This is a bacterial infection that can cause endophthalmitis in rare cases.
• Leukemia and Lymphoma: These are blood cancers that can cause endophthalmitis in rare cases.

Key Points:

• Endophthalmitis must be distinguished from noninfectious causes, such as TASS and phacoantigenic uveitis. [7]
• Bacterial endophthalmitis is a vision-threatening condition that requires prompt diagnosis and treatment. [10]
• Fungal endophthalmitis is a rare but serious condition that can occur after cataract surgery or trauma to the eye.

References:

[1] Jun 19, 2023 — Differential Diagnoses. Cavernous Sinus Thrombosis · Corneal Laceration · Corneal Ulcer and Ulcerative Keratitis in Emergency Medicine. [2] by S Kamjoo — 3.5 Differential Diagnosis of Acute Endophthalmitis; 3.6 Testing ... ' Differential Diagnosis of Acute Endophthalmitis. Occult retention ... [3] Jun 1, 2016 — Differential Diagnosis · Noninfectious uveitis. Idiopathic Sarcoidosis Behçet syndrome · Infectious chorioretinitis. Herpes simplex virus [4] by HW Flynn Jr · 2023 · Cited by 7 — Endophthalmitis is a clinical diagnosis, confirmed with subsequent laboratory testing. Endophthalmitis must be distinguished from noninfectious ... [5] Jan 14, 2018 — The most common symptom of TASS is blurred vision. Patients may present with blurred vision and mild pain on the same day of the surgery or ... [6] Oct 16, 2023 — Differential Diagnoses · Bacterial Endophthalmitis · Filtering Bleb Complications · Fungal Endophthalmitis · HLA-B27 Syndromes · Intraocular ... [7] by HW Flynn Jr · 2018 · Cited by 7 — Endophthalmitis is a clinical diagnosis, confirmed with subsequent laboratory testing. Endophthalmitis must be distinguished from noninfectious ... [8] by C Chiquet — The differential diagnoses are toxic anterior/posterior segment syndrome, phacoantigenic uveitis and inflammation of mechanical origin linked to ... [9] Aug 11, 2022 — Differential diagnosis: Cytomegalovirus; Acute retinal necrosis; Toxoplasmosis; Endophthalmitis; Syphilis; Tuberculosis; Leukemia; Lymphoma ... [10] by ML Durand · Cited by 33 — Acute bacterial endophthalmitis is a vision-threatening condition and must be managed as an emergency.