Summary about Disease
Endophthalmitis is a severe inflammation of the intraocular fluids (vitreous and aqueous humor) usually caused by infection. It represents a sight-threatening emergency and requires immediate diagnosis and treatment to prevent permanent vision loss. It can occur after eye surgery, eye injury, or, rarely, from an infection spreading through the bloodstream.
Symptoms
Symptoms of endophthalmitis can develop rapidly (acute) or gradually (chronic) and may include:
Eye pain (often severe)
Redness of the eye
Decreased vision or blurred vision
Sensitivity to light (photophobia)
Swelling of the eyelids
Discharge from the eye
Causes
Endophthalmitis is usually caused by:
Infection: Bacteria, fungi, or, rarely, viruses entering the eye. The most common route of entry is after eye surgery (e.g., cataract surgery) or penetrating eye injury.
Post-Surgical: This is the most common cause.
Trauma: Penetrating injuries allow direct entry of pathogens.
Endogenous: (Less common) Spread of infection from another part of the body through the bloodstream.
Medicine Used
Treatment typically involves:
Intravitreal antibiotics: Injection of antibiotics directly into the vitreous cavity. Common antibiotics include vancomycin (for gram-positive bacteria) and ceftazidime (for gram-negative bacteria).
Intravitreal antifungals: In cases of fungal endophthalmitis, antifungals like amphotericin B or voriconazole are used.
Topical antibiotics: Antibiotic eye drops.
Systemic antibiotics: Oral or intravenous antibiotics may be used in addition to intravitreal antibiotics, particularly in cases of endogenous endophthalmitis.
Corticosteroids: May be used to reduce inflammation, but are controversial and used with caution.
Is Communicable
Endophthalmitis is generally not communicable from person to person. It's caused by an infection within the eye itself, not a contagious pathogen that can be easily transmitted. However, if the source of the infection is from unsanitary surgical or medical equipment, others could potentially be affected if the same contaminated equipment is used.
Precautions
Precautions to minimize the risk of endophthalmitis include:
Strict sterile technique during eye surgery: Proper sterilization of instruments and preparation of the surgical field are crucial.
Prophylactic antibiotics: Antibiotic eye drops are often used before and after eye surgery to prevent infection.
Prompt treatment of eye injuries: Any penetrating eye injury should be treated immediately to prevent infection.
Good hygiene: Washing hands thoroughly before touching the eyes.
Careful management of systemic infections: Addressing infections elsewhere in the body to prevent them from spreading to the eye.
How long does an outbreak last?
Endophthalmitis is not typically described as an "outbreak" in the traditional sense of a communicable disease. Rather, cases arise individually due to surgery, trauma, or systemic infection. If a cluster of cases occurs in a specific location (e.g., a surgical center), it would indicate a breach in sterile technique or a contaminated source, and the "outbreak" would last until the source of the contamination is identified and eliminated. Individual cases can last from a few days to weeks or longer, depending on the severity of the infection, the speed of diagnosis, and the effectiveness of treatment.
How is it diagnosed?
Diagnosis involves:
Clinical examination: Assessing symptoms, visual acuity, and examining the eye with a slit lamp.
Vitreous tap (Aspiration): A small sample of vitreous fluid is taken for laboratory analysis.
Gram stain and culture: Identifying the causative organism (bacteria, fungus) from the vitreous sample.
Polymerase chain reaction (PCR): DNA analysis to identify specific organisms.
Ultrasound: If the view of the back of the eye is obscured, ultrasound can help assess inflammation and rule out other conditions.
Timeline of Symptoms
The timeline of symptoms can vary:
Acute Endophthalmitis: Symptoms typically develop rapidly, within days to a week after surgery or injury.
Delayed-Onset (Chronic) Endophthalmitis: Symptoms may develop weeks or even months after the inciting event.
Endogenous Endophthalmitis: The onset of symptoms may be more gradual. Generally, the symptoms progress if left untreated, with worsening pain, vision loss, and redness.
Important Considerations
Endophthalmitis is a medical emergency requiring immediate attention.
Prompt diagnosis and treatment are crucial to prevent permanent vision loss.
Even with appropriate treatment, some patients may experience significant vision impairment.
The prognosis depends on the virulence of the organism, the severity of the infection, and the speed of diagnosis and treatment.
Prevention through strict adherence to sterile technique during eye surgery is paramount.