L'endophthalmitis is a rare but serious form of inflammation of the eyeballdue to a infection of the intraocular cavity which, if not treated adequately and in a timely manner, can lead to irreversible loss of vision. Based on the route of infection transmission, endophthalmitis can be distinguished into exogenous or endogenous.
It is defined as exogenous endophthalmitis direct infection of the eye by microorganisms that enter the intraocular cavity through trauma or eye surgery. According to some studies, exogenous infection occurs in 11% of open-eye injuries and in approximately 0.1% of eyes undergoing intraocular surgery.
L'postoperative infectious endophthalmitis is, in fact, one of the most feared complications of eye surgery. Furthermore, exogenous infection can in turn be distinguished into acute or chronic. L'acute exogenous infection occurs a few days after the event and is extremely painful. In contrast, thechronic exogenous infection can develop months or even years after surgery (the average is about 9 months), is less common than acute and has a better prognosis due to the nature less severe than inflammation.
L'endogenous endophthalmitis arises when the infection of the eye is indirect, i.e. by micro-organisms that have spread through the bloodstream but originate from a distant infected site, e.g. the heart (endocarditis). Typical micro-organisms causing endogenous infection are bacteria such as Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, Escherichia coli and fungi such as Candida. Endogenous infection is rarer than exogenous: an estimated incidence of 5 per 10,000 hospitalised patients.
Usually one occurs in debilitated individuals and who are unable to activate an immune response against infection, such as drug users, chemotherapy patients and organ transplant recipients taking immunosuppressive drugs. Other risk factors include AIDS, poorly controlled diabetes mellitus and long-term steroid use.
Symptoms of endophthalmitis
In most cases, irrespective of its origin, endophthalmitis mainly presents with eye pain and reduced or blurred vision, is accompanied by photophobia, swelling of the eyelids, chemosis, redness. In some cases, pus may be present in the anterior chamber of the eye (the area between the iris and the lens), vitreitis (inflammation of the vitreous body) and retinal periphlebitis (inflammation of the blood vessels of the retina).
Diagnosis
In the case of suspected endophthalmitis an early diagnosis is essential: in addition to a normal eye examination, a bulbar ultrasound may be necessary. Evaluation may include ultrasound to better visualise the internal structures of the eye such as the vitreous and retina, and conjunctival or corneal swabs to identify the microorganisms underlying the infection.
Endophthalmitis: treatment
Depending on the severity of the infection, treatment includes sadministration of antibiotic, anti-fungal and/or antiviral drugs topically, orally, intravenously or by direct injection into the eye. If the infection is severe, a surgery vitrectomy in which the vitreous body (gelatinous liquid contained in the eyeball cavity) is removed and replaced with a similar medium (vitreous substitute).
Source
–Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clinical Ophthalmology. 2010
Dr. Carmelo Chines
Direttore responsabile
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