Endophthalmitis is a rare eye infection involving the fluids or internal structures of the globe. It's a medical emergency, and if not diagnosed and treated promptly, it results in permanent loss of vision. Exogenous endophthalmitis is the most prevalent form of the disease. It's where the infection is introduced into the eyeball from an outside source. It can occur after eye trauma, injection into the globe or eye surgery. Acute endophthalmitis is the most common and presents several days after an eye injury or treatment, while chronic endophthalmitis develops gradually and takes longer to manifest. Endogenous Endophthalmitis begins as an infection elsewhere in the body, such as a urinary tract infection or blood infection and spreads to the eye.
There are two main types of the condition:
- Exogenous endophthalmitis
- Endogenous endophthalmitis
Causes & Risk Factors
The infection can arise from:
In the US, most cases are associated with bacterial infections after eye surgery, such as cataracts and intraocular surgeries. Bacteria can also get into the eye through a foreign body piercing or cuts that make it easier for the pathogens to get inside the eyeball. Occasionally, particularly in immune-compromised individuals, an infection from another part of the body can spread to the eye via the blood.
Exogenous endophthalmitis risk factors include:
- Soil contamination
- Poor wound healing
- Longer surgery time
- A foreign body lodged in the eye
- Damage to the lens during trauma
- Eye injections and intraocular surgery
- Loss of vitreous humor, inner eye fluid
- Delayed surgery to repair a full-thickness wound
- Certain types of glaucoma surgery like glaucoma filtering have at life-long risk of developing the disorder
Signs & Symptoms
The symptoms may differ depending on the cause of the eye inflammation. Some symptoms that may arise soon after infection, i.e., within one to six days after eye injection, surgery or trauma to the eye. They may include:
- Red eyes
- Increased pain
- Pus or eye discharge
- Puffy or swollen eyelids
- Decreased or loss of vision in the affected eye
Symptoms can also occur later, for example, six weeks following the event. Usually, these symptoms are milder and may include:
- Mild eye pain
- Distorted or blurred vision
- Increased sensitivity to bright light
- The appearance of floaters in the field of vision
- A mild decrease in vision over several weeks
The patient should contact an ophthalmologist immediately if they develop any of the symptoms, particularly if they have a history of eye trauma, eye surgery, or any disease that weakens their immune system.
The ophthalmologist will review the symptoms and establish that detailed patient medical and eye surgery history as well as incidents of eye trauma. S/he will conduct a thorough eye examination, including physical evaluation, visual acuity test, slit-lamp exam and ultrasound scan. If the doctor suspects an infection s/he will conduct an aqueous/vitreous tap test. It involves obtaining a sample of the vitreous humor and testing it in the laboratory for bacteria or other organisms. The test helps the doctor to determine the most appropriate treatment option.
Treatment is determined by the cause of the infection and the condition of the affected eye. Where a bacterial infection causes the inflammation, the doctor can use antibiotics to treat the condition. Topical antibiotics may be applied to the infected wound, intravitreal antibiotics injected directly into the infected eye, and in severe cases, intravenous antibiotics can be administered into a vein.
In the case of a fungal infection, the doctor usually administers an antifungal agent into the affected eye. The patient may also receive an oral antifungal drug, or the medication can be given intravenously.
S/he may also prescribe corticosteroids to reduce swelling.
In acute cases, where the patient's vision is low or is blind, the ophthalmologist will conduct a vitrectomy surgery. It enables him/her to extract the infectious material from the eye and to administer antibiotics or antifungal medication directly into the eye.
To avoid complications after treatment, the patient must adhere to the doctor's eye care advice. If the patient is required to wear an eye patch, they should know where and how to place it. It's also essential to know how and when to apply any prescribed antibiotic eye ointment or drops.
Prognosis & Long-Term Outlook
The prognosis usually depends on the cause and duration of the infection. Generally, many patients have a good prognosis with proper treatment. Some gram-positive bacterial infection cases after cataract surgery fare better. However, often, in traumatic cases involving gram-negative organisms, the outcomes are less favorable.
Prevention & Follow Up
It's critical to follow the doctor's home care instructions after an eye injection or eye surgery. The patient must apply the prescribed medication as directed and wash their hands before putting the eye drops. They should also avoid the eye drop bottle touching the eye because it can contaminate the dropper.
It's essential to use protective eyewear during contact sports and at work to prevent eye trauma. Protective gear such as helmets, eye shields and goggles can protect against debris that could cut or pierce the eyes leading to infection.
The patient must keep all follow-up appointments with the ophthalmologist to obtain the best outcomes. It enables him/her to monitor the progress and detect any complications.