Endophthalmitis

Endophthalmitis is a serious eye infection. It can affect the vitreous body, the retina, the uvea, the sclera and evolve to become panophthalmitis, a widespread inflammatory process that affects all the structures of the eyeball. An eye emergency should be considered. The infection can spread rapidly beyond the borders of the eyeball, thus affecting the orbital cavity and the central nervous system.

What Are the Causes?

They can be bacteria, fungi and viruses. In most cases, the infection has an external origin. The pathogen comes from the environment, first affecting the eyelid’s edge and the tear film that covers the eyelid and the bulbar conjunctiva as well as the cornea.

The infection can also be transmitted by foreign bodies that enter the eye due to a perforating trauma or intraocular surgical treatments.

Endophthalmitis caused by surgical operations can occur immediately after surgery, often acutely, or late. Generally, they occur immediately after operations (24-72 hours), with pain and severe reduction of vision, swelling of the eyelids (or eyelid edema), redness, corneal and vitreous body inflammation (which fills the eyeball).

Endogenous origin by blood diffusion is less frequent, i.e. through blood circulation. The causes can be systemic surgery, abscesses, recent dental procedures, intravenous injections, parenteral nutrition, hemodialysis and even treatments with immunosuppressive drugs. In this case, the primary cause of the infection is fungi such as Candida albicans or Aspergillus fumigatus.

What Are the Symptoms?

The infection has eye pain as its main symptom. It can lead to functional damage to the eye, which leads to a reduction in vision up to the risk of anatomical loss.

Photophobia, swelling of the eyelids, chemosis (protrusion) and hyperemia of the conjunctiva (redness) occur but pus can also occur inside the eye (in the area between the iris and the crystalline lens, called the anterior chamber), vitritis (inflammation of the vitreous body) and retinal periphlebitis (inflammation of the blood vessels of the retina in bacterial forms).

How is the Diagnosis Performed?

The diagnosis is based on the strong suspicion of endophthalmitis in people with particular risk factors. The specialist examines the eye with a slit lamp and, in case of bad visualization, can resort to ultrasound.

It is important to carry out laboratory tests on samples taken using conjunctival or corneal swabs, as in the case of ulcers, to identify the possible cause and – by means of an antibiogram – evaluate any resistance to antibiotics and, therefore, adopt a more targeted therapy.

How Can It Be Treated?

Surgery is the only really effective therapy and many times it is useful as to isolating the cause that is responsible for the infection.

What Kind of Surgery?

Vitrectomy is performed. With this procedure, the vitreous body is removed and a certain quantity of vitreous material is taken which is subjected to a culture and / or antibiogram examination.

It is also possible to perform an ocular injection (intravitreal administration) of an antibiotic with a broad spectrum of action and, in some cases, removal of the natural or artificial lens is necessary.

Should Any Therapy Be Followed After the Operation?

Yes. It is important to undertake local therapy with antibiotic ointments and apply eye protection for a period of time as indicated by the surgeon. Local therapy is often associated with systemic therapy (i.e. taking antibiotics).

This helps the operated eye to heal better and prevent any complications. In fact, by not correctly and scrupulously carrying out the treatments, dressings and checks following the operation can compromise the success of the operation itself.

Can You Recover Your Sight?

The recovery of vision after the surgery depends on the severity of the infection and pre-existing general conditions of the eye, i.e. the state of the retina, the optic nerve and the cornea. In fact, the presence of a lesion, caused by the infection of these ocular structures, can limit the visual recovery following the operation.

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