Endophthalmitis Acute/Chronic (SEQs, MCQs, OSCE, Viva)

Summary

Endophthalmitis is a rare yet severe complication, often occurring after ocular surgeries like cataracts or glaucoma treatments. It can be either exogenous (post-surgery or trauma) or endogenous (due to systemic infections like septicemia or endocarditis). The condition manifests with symptoms such as pain, vision loss, and inflammation. Timely diagnosis and treatment are crucial, involving intraocular antibiotics, vitrectomy, or both. Risk factors include age, diabetes, and prolonged surgeries. Early intervention and targeted treatment are key to improving outcomes, as delayed or improper management can lead to blindness or other complications.

Takeaways

• 😀 Endophthalmitis is a rare but severe eye infection, often leading to blindness if not treated promptly.
• 😀 It typically occurs after intraocular surgery, like cataract surgery, or post-traumatic events.
• 😀 The condition can be either acute or chronic, and early diagnosis and treatment are critical for improving outcomes.
• 😀 Exogenous endophthalmitis is the most common form, usually caused by pathogens like *Staphylococcus epidermidis* and *Staphylococcus aureus*.
• 😀 Endogenous endophthalmitis is caused by systemic infections, such as endocarditis or osteomyelitis, affecting the eye.
• 😀 Key diagnostic tools include B-scan ultrasound, anterior chamber (AC) tap, vitreous tap, and biopsy for culture sensitivity.
• 😀 The primary treatment involves intravitreal antibiotics within 24-48 hours of diagnosis, with possible vitrectomy in severe cases.
• 😀 Risk factors for developing endophthalmitis include advanced age, diabetes, prolonged surgery, contaminated instruments, and poor post-operative care.
• 😀 Prophylactic measures include careful draping, iodine use, and intracameral antibiotic injections during surgery.
• 😀 Common complications from untreated endophthalmitis include vision loss, glaucoma, and the need for enucleation or evisceration of the eye.
• 😀 The prognosis depends on the duration of infection before treatment, the virulence of the organism, and the host's inflammatory response.

Q & A

What is endophthalmitis and why is it significant?

Endophthalmitis is a rare but severe infection that can result in blindness, typically occurring after intraocular surgeries like cataract surgery. It is a critical condition because of its potential to cause irreversible damage to the eye, leading to vision loss if not treated promptly.

What are the two types of endophthalmitis and their causes?

Endophthalmitis can be classified as exogenous or endogenous. Exogenous endophthalmitis typically occurs after ocular surgeries or trauma, with *Staphylococcus epidermidis* and *Staphylococcus aureus* being the most common organisms involved. Endogenous endophthalmitis results from systemic infections, such as sepsis, endocarditis, or osteomyelitis.

What are the signs and symptoms of endophthalmitis?

Common signs and symptoms include pain, worsening vision, increased post-operative inflammation, hypopyon (pus in the anterior chamber), posterior segment inflammation (vitritis), fibrinous exudation, impaired fundal glow, loss of red reflex, lid swelling, and corneal haze. RAPD (Relative Afferent Pupillary Defect) suggests a poor prognosis.

How is endophthalmitis diagnosed?

Endophthalmitis is diagnosed clinically, based on the patient's history and clinical examination. Non-invasive investigations like B-scan ultrasonography can help assess vitreous activity and the retinal status. For chronic cases, anterior chamber or vitreous taps, along with culture and sensitivity testing, may be performed.

What is the role of early treatment in managing endophthalmitis?

Early diagnosis and prompt treatment are crucial for preventing permanent damage. Intravitreous antibiotics should be administered within 24-48 hours. Other interventions include vitrectomy, intracameral injections, and systemic antibiotics, depending on the case.

What are the common treatment methods for endophthalmitis?

Treatment options include intravitreous antibiotics (preferably within 24-48 hours), anterior chamber vitrectomy with antibiotics, topical or fortified eye drops, intracameral injections, and systemic antibiotics. The choice of treatment depends on the severity and timing of the infection.

What factors affect the prognosis of endophthalmitis?

The prognosis of endophthalmitis is influenced by factors such as the duration of infection before treatment, the virulence of the infecting organism, the patient’s overall health, and the promptness of treatment. Early intervention improves the chances of preserving vision.

What are the main risk factors for developing endophthalmitis?

Risk factors include pre-existing ocular conditions (e.g., blepharitis or conjunctivitis), advanced age, comorbidities like diabetes, complicated or prolonged surgeries, combined surgical procedures, contaminated surgical instruments, improper antiseptic protocols, and lack of post-operative antibiotic injections.

What complications can arise from endophthalmitis?

Complications include vision loss or blindness, glaucoma, phthisis bulbi (shrunken eye), and difficulty with post-operative healing. Additionally, certain antibiotics like ceftazidime and vancomycin can precipitate if not administered in separate syringes.

What is the significance of the Endophthalmitis Vitrectomy Study (EVS)?

The Endophthalmitis Vitrectomy Study (EVS) provided important insights into the management of endophthalmitis. It showed that early vitrectomy with intravitreous antibiotics is associated with better outcomes compared to delayed treatment, particularly in cases of severe infection.