ENDOPHTHALMITIS
Description
Endophthalmitis is a purulent inflammation of the intraocular fluids (vitreous and aqueous) usually due to infection. Serious intraocular inflammatory disorder resulting from infection of the vitreous cavity. Progressive vitritis is the hallmark of any form of endophthalmitis. Histologically: massive infiltration of the vitreous cavity with inflammatory cells
Endophthalmitis is of two types: (1) exogenous endophthalmitis caused by the direct inoculation of infecting agent through breach in the continuity of ocular coats, e.g. postoperative, post-traumatic, (2) endogenous endophthalmitis results due to haematogenous spread of infective agents. Depending upon the aetiology of infectious agents, both these categories
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The doctor anesthetizes the eye. He or she then uses a tiny needle to withdraw some of the eye's internal fluid. This fluid is tested for bacteria or other organisms.
Diagnosis is done on the basis of visible features
1. History of eye surgery, penetrating injury, fever, infection or predisposing systemic diseases leading to metastatic endophthalmitis.
2. Marked visual loss, ocular pain, headache, ocular discharge, photophobia, intense redness and lid swelling.
3. Ocular examination reveals conjunctival and ciliary congestion, profound decrease in vision even up to perception of light with accurate or inaccurate projection of rays. Corneal oedema, hypopyon, signs of uveitis, reduction in intraocular pressure, exudation in vitreous leading to reduced or absent fundus reflex are the other associated features. The clinical picture is variable depending upon the route of entry, infectious process and duration of disease.
Precaution & Prevention:
The prognosis is better if one does not attempt to squeeze or puncture the Endophthalmitis, as infection may spread to adjacent tissues. Also, patients are recommended to call a doctor if they encounter problems with vision, the eyelid bump becomes very painful, the Endophthalmitis bleeds or reoccurs, or the eyelid or eyes becomes
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Topical antibiotic eye drops or ointment (e.g., chloramphenicol or fusidic acid) are sometimes used for the initial acute infection, but are otherwise of little value in treating a Endophthalmitis. Endophthalmitis will often disappear without further treatment within a few months, and virtually all will reabsorb within two years. Healing can be facilitated by applying warm compress to the affected eye for approximately 15 minutes 4 times per day. This promotes drainage and healing by softening the hardened oil that is occluding the duct.
Postoperative bacterial endophthalmitis
1. Intravitreal injection of antibiotics—Inj. Vancomycin hydrochloride 1 mg in 0.1 ml plus Inj. Ceftazidime 2 mg in 0.1 ml or Inj. Amikacin sulphate 0.4 mg in 0.1 ml.
2. Subconjunctival injection Vancomycin 25 mg/0.5 ml plus Ceftazidime 100 mg/0.5 ml plus Dexamethasone 0.25 mg/0.5 ml.
3. Vancomycin eyedrops 50 mg/ml plus Amikacin eyedrops 15 mg/ml 1 drop every 6 hours.
4. Homatropine 2% eyedrops 3 times a day or Atropine 1% eye ointment 2 times a day.
5. Prednisolone acetate 1% eye drops or Dexamethasone or Betamethasone 0.1% eyedrops every 6