Pediatric endophthalmitis refers to a rare infection within the globe (eyeball). It is a severe medical emergency because it affects the sterile, delicate tissues and fluids inside the eyeball. Endophthalmitis can quickly result in blindness if not treated and even lead to loss of the eye. Often, the eye's inside is protected against harmful external organisms like fungus or bacteria. Endophthalmitis can also be caused by previous eye surgery or trauma.
Though rare, pediatric endophthalmitis is potentially challenging because of the differences in presentation between adults and children. While adults immediately notice the unusual pain or blurry vision, children may not explain their symptoms for prompt treatment. Besides, some specific factors affecting children such as malnourishment, a compromised immunological status, and variable systemic features, may affect Endophthalmitis’ resolution.
Two main types of endophthalmitis exist, namely:
Here, the source of the infection is outside the body, mostly puncture wounds. It is the most popular type where fungi or bacteria enter the eye through eye injury, an injection into the eye, or surgery. This type is further divided into two types. The first is called acute endophthalmitis, which arises when the symptoms develop quickly only a few days following the injury or surgery. The second subtype is chronic endophthalmitis, where the symptoms develop slowly after infection with specific fungi or bacteria types
In this type, the infection begins in another part of the body before spreading to the eye. An example is an infection of the urinary tract that spreads to the eye
Causes & Risk Factors
Endophthalmitis is caused by bacteria or fungi that enter the eye to cause infection. Literature indicates that most cases of endophthalmitis are due to trauma or injury to the eye. Sometimes foreign bodies carrying the fungi or bacteria remain in the eye. One study found that the most common source of trauma was scissors, followed by disposable syringes.
Previous eye surgery such as cataract, corneal transplantation, and glaucoma can cause endophthalmitis from days to even two years after surgery. Those who have undergone a type of glaucoma surgery called trabeculectomy are predisposed to a life-long risk of developing endophthalmitis. Though very rare, eye muscle surgery can also lead to endophthalmitis.
Endogenous endophthalmitis is the least common in children.
Signs & Symptoms
The signs and symptoms of endophthalmitis in children are like those in adults and may include:
- Eye pain
- Swelling around the eye
- Chemosis (eye irritation)
- Photophobia or sensitivity to light
- Vitritis (inflammation of the vitreous)
- Yellow or white discharge from the eye
- Progressive vision deterioration or loss of vision
- Vitreous exudates (mass of cells and fluids in the vitreous)
- Some children may present with rare and unusual features such as granulomas (inflammation) in the posterior segment of the eye
- Pain and loss of vision two to three days after surgery or even weeks following the procedure. The pain gets worse with time
Endophthalmitis needs to be diagnosed promptly to save a child’s vision. It can be made through:
- A regular eye examination which includes testing for visual acuity
- A patient’s medical history, especially if the patient has had recent eye surgeries, injuries, or eye injections
- Ultrasound for better visualization of the eye’s inner structures like the retina and vitreous. This test can show if there are foreign bodies in the eye
- Microbiology studies or an aqueous/vitreous tap where a sample is drawn from the eye using a needle. This is done to identify the organism causing the infection
Treatment is aimed at clearing the infection from the system.
Antibiotics, anti-fungal, and antiviral drugs can be used to treat endophthalmitis. These medicines can be taken by mouth, through eye injections, injections in the veins, or applied as ointments directly on the eye. Sometimes steroids can help to reduce inflammation in the eye. Often a combination of these methods is used.
Surgery is an option when some infectious material is still lodged inside the eye. A vitrectomy is performed where vitreous gel is removed and replaced with a saline solution. Medicine is then injected to prevent infection.
Prognosis & Long-Term Outlook
The prognosis is varied and depends on several factors such as severity, the extent of the damage, and the cause of infection. If the infection is mild, the child often experiences excellent visual outcomes after treatment. However, if endophthalmitis does not respond to treatment and is a threat to life, it will lead to not only permanent loss of vision but eyeball removal in procedures called enucleation or evisceration.
Prevention & Follow Up
Preventive measures, such as avoiding eye injuries, can help. If the child can wear protective eyewear, tforeign material can be prevented from entering the eye. After eye surgery and eye injection, the parent or caregiver should closely follow the surgeon’s instructions. For instance, before putting eye drops into the child's eye, the caregiver should wash their hands.
Further, the eye drop bottle should not touch the eye to prevent the dropper from getting contaminated.
The follow-up period depends on the severity of the condition and response to treatment. This period can range from five months to four years.