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Disease

Endophthalmitis

Definition: 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 endogenous endophthalmitis.

Early Signs & Symptoms:

• dramatic decrease in vision in the affected eye
• eye pain that becomes worse
• red eyes and swollen eyelids

Late Signs & Symptoms (tend to be milder than early symptoms):

• blurred vision
• increased sensitivity to bright light (photophobia)
• mild eye pain

Diagnosis: 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, may be used to look at the internal structures of the eye.  The doctor may recommend a procedure called a vitreous tap in which a tiny needle is used to withdraw some of the eye’s internal fluid. This fluid is then tested for bacteria or other organisms.

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.

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.