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Endophthalmitis

Fig. 1 External view of eye with endophthalmitis.

What is endophthalmitis?

Endophthalmitis is an infection inside the eyeball (globe). The inside of the eye is sealed and sterile and typically not exposed to external organisms. Because the tissues within the eyeball are very delicate, endophthalmitis is very serious and can lead to blindness and even loss of the eye itself. The outside of eye is in constant contact with viruses, fungi and bacteria and infection of this part of the eye is conjunctivitis or keratitis

How does endophthalmitis occur?

There are two ways to contract endophthalmitis. Exogenous endophthalmitis is the most common form and occurs after penetration of the eyeball from trauma, surgery or erosion of an external eye infection into the eye. It is among the most serious complications of eye surgery. In contrast, endogenous endophthalmitis occurs when infectious organisms invade the inside of the eye from the bloodstream. This occurs more commonly in individuals with severe blood born infections, often when the immune system is compromised.

Fig. 2 Interior of eye with endophthalmitis showing hazy view of retina and vitreous.

What types of eye surgery result in endophthalmitis?

Despite meticulous sterile technique, any eye surgery may cause endophthalmitis. Endophthalmitis is most common (1 in 1000) following intraocular surgery such as cataract, cornea transplantation and glaucoma filtering. Other types of surgery, such as eye muscle surgery, can also lead to endophthalmitis. Fortunately, endophthalmitis following eye muscle surgery is very rare (about 1 in 30,000 cases).

What are the symptoms of endophthalmitis?

The symptoms of endophthalmitis include progressive deterioration of vision, light sensitivity, pain and swelling around the eye [See figures 1 and 2]. If there is loss of vision after eye surgery, especially accompanied by pain, a physician should be notified. Endophthalmitis typically occurs between 2 and 5 days after surgery but some mild forms may occur weeks after surgery. Patients that have undergone a glaucoma "filtering" procedure are at life-long increased risk for developing endophthalmitis.

How is endophthalmitis diagnosed and treated?

Prompt diagnosis of endopthalmitis is essential. Evaluation, in addition to a regular eye exam, may include a needle into the eye to check for infection or to inject antibiotics directly into the eye. Topical eye drops, oral or intravenous antibiotics may be prescribed. Steroids are sometimes utilized. If the infection is severe, a surgery called a "vitrectomy" may be performed to remove infectious material from the inside of the eye.

What is the prognosis from endophthalmitis?

Prognosis of endophthalmitis varies widely depending upon the severity of the infection, the organism involved and the amount of damage the eye sustains from inflammation and scarring. Mild cases of endophthalmitis can have excellent visual outcomes. Severe cases may result not only in loss of sight, but eventually in loss of the entire eye.