Endophthalmitis

What Is It?

Endophthalmitis is an inflammation of the inside of the eye, including the central cavity of the eye, which is filled with a clear, gel-like substance called vitreous fluid. Inflammation also affects surrounding tissues that are responsible for vision. In most cases, an infection triggers this inflammation. The infection can be caused by bacteria, fungi (microscopic organisms related to molds and mushrooms), viruses or parasites.

In the United States, most cases of endophthalmitis are caused by bacterial infections that follow eye surgery, such as procedures to treat cataracts or glaucoma. Bacteria also can enter the eye through an injury that pierces the eye.

Less often, an infection from somewhere else in the body can travel to the eye through the blood. This is called hematogenous endophthalmitis.

Symptoms

The most common symptom of endophthalmitis is loss of vision. Additional symptoms vary, depending on what caused the eye infection:

• Postoperative endophthalmitis The most common cause of endophthalmitis is a bacterial infection after cataract surgery. This serious problem can lead to permanent loss of vision. Symptoms vary slightly, depending on whether the infection occurs early (six weeks or less) or late (months or years) after surgery.
  • Early symptoms can include a dramatic decrease in vision in the affected eye, eye pain that becomes worse after surgery, red eyes and swollen eyelids.
  • Late symptoms tend to be milder than early symptoms and may include blurred vision, increased sensitivity to bright light (photophobia) and mild eye pain.
• Posttraumatic endophthalmitis Symptoms of endophthalmitis caused by a penetrating eye injury are generally dramatic a dramatic decrease in vision in the affected eye, eye pain that becomes worse, red eyes and swollen eyelids.
• Hematogenous endophthalmitis When an infection spreads through the bloodstream and settles in the eye, symptoms may develop gradually and be fairly subtle. For example, the person may notice a mild decrease in vision over a period of a few weeks, along with the appearance of floaters, which are dark, semi-transparent, floating shapes in the field of vision.

Diagnosis

Because endophthalmitis can lead to serious vision problems, a medical doctor who specializes in eye problems (an ophthalmologist) must diagnose and treat it. After reviewing your symptoms, the doctor will ask about your medical history, especially any eye surgery or eye trauma.

The doctor will examine your eyes, and test how well you see in both eyes. The doctor will use a lighted instrument for looking inside the eye (an ophthalmoscope). An ultrasound, the same kind that produces images of a fetus in the womb, is used to look at the internal structures of the eye.

The ophthalmologist may recommend a procedure called a vitreous tap. To perform this procedure, the ophthalmologist anesthetizes the eye and uses a tiny needle to withdraw some of the eye's internal fluid. This fluid is then tested for bacteria or other organisms.

Expected Duration

For the best chance to preserve and restore your vision, endophthalmitis must be treated promptly. Once treatment begins, symptoms can begin to improve within 24 to 48 hours. In many cases, eye pain and eyelid swelling lessen before vision gets better.

Prevention

If you have had cataract surgery, you can help to decrease your risk of infection by following your doctor's instructions for eye care after your surgery and by seeing your doctor regularly for follow-up eye exams.

To prevent endophthalmitis caused by eye trauma, use protective eyewear at work and during contact sports. Goggles, eye shields and helmets can help protect against industrial debris that can pierce or cut the eyes.

Treatment

Treatment depends on what causes the endophthalmitis and the state of vision in the affected eye. For endophthalmitis caused by a bacterial infection, options include one or more of the following:

• Intravitreal antibiotics Antibiotics are injected directly into the infected eye. Usually, some vitreous is removed for diagnostic purposes and to make room for the antibiotic.
• Corticosteroids Your doctor may inject corticosteroids into your eye to decrease inflammation and speed healing.
• Intravenous antibiotics Antibiotics, given by vein, may be prescribed for patients with severe endophthalmitis.
• Topical antibiotics Antibiotics are applied to the surface of the eye when there is a wound infection in addition to endophthalmitis.
• Vitrectomy Part of the eye's infected vitreous fluid is removed and replaced with a salt solution (sterile saline) or other compatible liquid. This usually is done if vision loss is so severe that the person is nearly blind.

To treat endophthalmitis caused by a fungal infection, doctors usually inject an antifungal medication (such as amphotericin B) directly into the infected eye. The medication may be given intravenously or the person may receive an oral antifungal drug, such as fluconazole.

The ophthalmologist will monitor your progress. You will have frequent eye exams to keep the doctor informed about whether the treatment is improving your vision or not.

When To Call A Professional

Endophthalmitis is a medical emergency than can cause permanent loss of vision if not diagnosed and treated promptly. Call your doctor immediately if you develop symptoms of endophthalmitis, especially if you have a history of eye surgery, eye trauma or any condition that weakens your immune defenses.

Prognosis

With proper treatment, many people have a good prognosis. According to one large study by the National Eye Institute, more than 50% of people treated for endophthalmitis after cataract surgery ultimately achieved 20/40 vision (the ability to see at 40 feet what a person with perfect vision can see at 20 feet).

Additional Info

National Eye Institute

2020 Vision Place

Bethesda, MD 20892-3655

Phone: 301-496-5248

http://www.nei.nih.gov/

American Academy of Ophthalmology

P.O. Box 7424

San Francisco, CA 94120-7424

Phone: 415-561-8500

Fax: 415-561-8533

http://www.aao.org/news/eyenet/

American Optometric Association

243 North Lindbergh Blvd.

St. Louis, MO 63141

Phone: 314-991-4100

Fax: 314-991-4101

http://www.aoanet.org/