Endophthalmitis is an inflammatory process of the inner layers of the eye, which may be either infectious Infectious Febrile Infant or sterile Sterile Basic Procedures. Infectious Infectious Febrile Infant endophthalmitis can lead to irreversible vision Vision Ophthalmic Exam loss if not treated quickly. Based on the entry mode of the infectious Infectious Febrile Infant source, endophthalmitis is divided into endogenous and exogenous types. Exogenous endophthalmitis occurs via direct inoculation of infectious Infectious Febrile Infant organisms during cataract Cataract Partial or complete opacity on or in the lens or capsule of one or both eyes, impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). Neurofibromatosis Type 2 surgery, ocular trauma Ocular Trauma Cataracts in Children, or intravitreal injection. Endogenous endophthalmitis results from hematogenous Hematogenous Hepatocellular Carcinoma (HCC) and Liver Metastases seeding Seeding The local implantation of tumor cells by contamination of instruments and surgical equipment during and after surgical resection, resulting in local growth of the cells and tumor formation. Grading, Staging, and Metastasis. Sterile Sterile Basic Procedures endophthalmitis may result from toxins or retained lens Lens A transparent, biconvex structure of the eye, enclosed in a capsule and situated behind the iris and in front of the vitreous humor (vitreous body). It is slightly overlapped at its margin by the ciliary processes. Adaptation by the ciliary body is crucial for ocular accommodation. Eye: Anatomy material after an ocular operation. Clinical features vary depending on the type and course of the disease. Features may include decreased vision Vision Ophthalmic Exam, conjunctival injection, ocular pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, hypopyon Hypopyon Diseases of the Uvea, and corneal edema Edema Edema is a condition in which excess serous fluid accumulates in the body cavity or interstitial space of connective tissues. Edema is a symptom observed in several medical conditions. It can be categorized into 2 types, namely, peripheral (in the extremities) and internal (in an organ or body cavity). Edema. The diagnosis primarily depends on history and ophthalmological examination, and treatment is based upon the underlying cause. Sterile Sterile Basic Procedures endophthalmitis generally resolves spontaneously while infectious Infectious Febrile Infant endophthalmitis is treated with antimicrobials (antibiotics or antifungals). Vitrectomy Vitrectomy Removal of the whole or part of the vitreous body in treating endophthalmitis, diabetic retinopathy, retinal detachment, intraocular foreign bodies, and some types of glaucoma. Retinal Detachment may be needed in severe disease.
Last updated: 6 May, 2022
Endophthalmitis is an inflammatory process of the intraocular cavities (e.g., aqueous and/or vitreous humor Vitreous humor The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyaloid membrane and forms about four fifths of the optic globe. Eye: Anatomy) usually caused by bacteria Bacteria Bacteria are prokaryotic single-celled microorganisms that are metabolically active and divide by binary fission. Some of these organisms play a significant role in the pathogenesis of diseases. Bacteriology or fungi Fungi A kingdom of eukaryotic, heterotrophic organisms that live parasitically as saprobes, including mushrooms; yeasts; smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi, commonly known as molds, refer to those that grow as multicellular colonies. Mycology.
Exogenous:
Endogenous:
Normally, the ocular-blood barrier naturally resists invasive organisms.
Pathophysiology:
Risk factors:
Pathophysiology:
In unilateral cases, the right eye Right Eye Refractive Errors is twice as likely as the left eye Left Eye Refractive Errors to become infected.
Risk factors:
Acute:
Chronic:
Hypopyon Hypopyon Diseases of the Uvea and track of pus with endophthalmitis associated with glaucoma Glaucoma Glaucoma is an optic neuropathy characterized by typical visual field defects and optic nerve atrophy seen as optic disc cupping on examination. The acute form of glaucoma is a medical emergency. Glaucoma is often, but not always, caused by increased intraocular pressure (IOP). Glaucoma shunt intraluminal stent exposure Exposure ABCDE Assessment
Image: “ Hypopyon Hypopyon Diseases of the Uvea and track of pus from tube at presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor with endophthalmitis” by Jaypee Brothers Medical Publishers (P) Ltd. License: CC BY 3.0Endophthalmitis diagnosis is based on clinical presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor with confirmation by laboratory testing of aqueous and/or vitreous humor Vitreous humor The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyaloid membrane and forms about four fifths of the optic globe. Eye: Anatomy.
Fundoscopy Fundoscopy Cranial Nerve Palsies:
A fundoscopic examination of a patient with endogenous fungal endophthalmitis demonstrates a yellow retinal lesion medial to the optic nerve Optic nerve The 2nd cranial nerve which conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. The 12 Cranial Nerves: Overview and Functions.
Image: “Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold Mold Mycology and yeast Yeast A general term for single-celled rounded fungi that reproduce by budding. Brewers’ and bakers’ yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried. Mycology infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease.” by Sridhar J, Flynn HW, Kuriyan AE, Miller D, Albini T. License: CC BY 2.0Slit-lamp examination Slit-Lamp Examination Blepharitis:
Diagnostic testing supports workup to search for the source of endogenous endophthalmitis:
Management depends on the underlying cause and outcome is extremely dependent on timely diagnosis and treatment.
Fungal:
Bacterial: