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Endophthalmitis

Endophthalmitides

Endophthalmitis is an infection of the vitreous body and the inner coat of the eye caused by bacteria or fungi. Inoculation of microorganisms from the external environment during surgery, trauma and hematogenous spread from distant sites in the body are the two modes of infection. Without an early diagnosis, blindness can develop rapidly.


Presentation

Depending on the cause, the clinical presentation may somewhat vary:

  • Postoperative - Cataract surgery, secondary intraocular lens (IOL) implantation, penetrating keratoplasty, glaucoma drainage device implantation, trabeculectomy and vitreous procedures (vitrectomies or intravitreal injections) have all been associated with an increased risk for postoperative endophthalmitis [1] [2]. Symptoms can develop within the first six weeks (acute-onset) or after six weeks (delayed- onset) [1] [3]. Decreased visual acuity, eye pain, eyelid edema, ocular discharge, inability to visualize the fundus and hypopyon are typical signs, while the loss of red fundus reflex, light perception, and papillitis are seen in more severe cases [3] [4]. An insidious and prolonged clinical course is common for delayed-onset endophthalmitis [3] [4].
  • Posttraumatic - Approximately 25% of endophthalmitis occurs in the setting of ocular trauma [3], with decreased vision, swelling of the eyelid, severe eye pain, uveitis, vitritis, hypopyon and presence of corneal ring ulcers being the most important symptoms [3].
  • Endogenous - Symptoms of endophthalmitis as a result of hematogenous spread of bacterial or fungal organisms may be similar to exogenous forms, the most important signs being reduced visual acuity, eyelid edema, eye pain, and hypopyon [5]. Additionally, photophobia and the presence of floaters can also be reported in the majority of patients [5]. An absence of the red fundus reflex along with corneal edema and impaired visualization of the fundus, like in other forms, is frequently observed [5].
Fever
  • A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation.[ncbi.nlm.nih.gov]
  • We describe an 84-year-old man who presented to the emergency department with fever, orbital cellulitis, and bilateral visual loss. Although the patient had no overt abdominal symptoms, computed tomography scan revealed a pyogenic liver abscess.[ncbi.nlm.nih.gov]
  • A previously healthy 42-year-old man presented to the Emergency Department with chills, fever, left wrist pain, left eye pain, and vision loss.[ncbi.nlm.nih.gov]
  • The patient's systemic and ocular condition improved and the patient no longer had fever.[scielo.br]
  • The patient was hospitalised due to general decline, fever and dyspnoea. As a respiratory infection was suspected, systemic empirical antibiotic coverage was provided with ceftriaxone.[revistanefrologia.com]
Fishing
  • Results: With PNA-FISH technique, Staphylococcus aureus was identified in 9 of 10 samples and coagulase-negative staphylococci were identified in 10 of 10 samples. Detection time was 20 minutes.[ncbi.nlm.nih.gov]
Nightmare
  • Abstract Occurrence of postoperative cluster endophthalmitis is a nightmare for the operating surgeon, the involved hospital, and the patients.[ncbi.nlm.nih.gov]
Wrist Pain
  • A previously healthy 42-year-old man presented to the Emergency Department with chills, fever, left wrist pain, left eye pain, and vision loss.[ncbi.nlm.nih.gov]
Eye Pain
  • Decreased visual acuity, eye pain, eyelid edema, ocular discharge, inability to visualize the fundus and hypopyon are typical signs, while the loss of red fundus reflex, light perception, and papillitis are seen in more severe cases.[symptoma.com]
  • He complained of a headache and blurry vision but denied having eye pain. Slit-lamp examination demonstrated leukocytes with a fibrinous membrane in the anterior segment and vitritis.[ncbi.nlm.nih.gov]
  • A 64-year-old man with type 2 diabetes mellitus and plaque psoriasis presented to the emergency room with 3 days of progressive right eye pain and decreased vision.[ncbi.nlm.nih.gov]
  • RESULTS: A 60-year-old woman presented with eye pain and loss of vision 6 days after uncomplicated strabismus surgery for thyroid eye disease.[ncbi.nlm.nih.gov]
  • A previously healthy 42-year-old man presented to the Emergency Department with chills, fever, left wrist pain, left eye pain, and vision loss.[ncbi.nlm.nih.gov]
Visual Acuity Decreased
  • The visual acuity decreased to hand motions or light perception postoperatively. The culture of aqueous and vitreous of the 2 eyes revealed Staphylococcus epidermidis and enterococcus faecalis respectively, however was negative for the third eye.[ncbi.nlm.nih.gov]
  • Common symptoms and signs of acute infective exogenous endophthalmitis Symptoms Signs Visual blurring or loss Pain Purulent discharge Decreased visual acuity Decreased red reflex Eyelid oedema Conjunctival injection and chemosis Anterior chamber cells[racgp.org.au]
  • acuity decreased below the level expected Lid edema Conjunctival hyperemia Corneal edema Anterior chamber cells and flare Keratic precipitates Hypopyon [5] Fibrin membrane formation Vitritis Loss of red reflex Retinal periphlebitis if view of fundus[emedicine.medscape.com]
Corneal Opacity
  • Permanent loss of vision in patients with AOPE can occur through a variety of mechanisms, including retinal detachment, hypotony, and corneal opacity.[academic.oup.com]
Headache
  • He complained of a headache and blurry vision but denied having eye pain. Slit-lamp examination demonstrated leukocytes with a fibrinous membrane in the anterior segment and vitritis.[ncbi.nlm.nih.gov]
  • Common cold with headache and unintentional body weight loss was also noted recently. Choroidal detachment simulating choroidal tumor was observed in the temporal quadrant.[ncbi.nlm.nih.gov]
  • Symptoms : Symptoms of endophthalmitis includes loss of vision (partial), blurred vision, headache, pain in the eyes, photophobia, ocular discharge and intense ocular inflammation.[diseasespictures.com]
  • Generally, patient complains of sudden loss of vision, pain, redness, swelling of the eye, headache, and photophobia. However severity of symptoms may depend on the causative organism.[drushti.com]

Workup

A thorough patient history is the first step in workup, as it can reveal vital clues regarding risk factors and pathogenesis of eye-related problems. Many authors suggest that typical signs and symptoms encountered in endophthalmitis are sufficient to make a diagnosis [1] [4] [5], but fundoscopy and a slit-lamp examination to support these findings must be performed. Vitritis, corneal infection, hypopyon, and clumps of thick material in the anterior chamber are some of the most common findings [4]. Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT scan) must be performed in the post-traumatic eye injury to exclude the presence of foreign bodies in other sites [1]. To confirm the underlying cause and determine optimal therapy, microbiological studies are necessary. A sampling of the vitreous humor, either by performing a vitrectomy or needle aspiration, is needed in order to obtain a viable sample for the investigation [4] [5]. Identification of bacterial or fungal pathogens are performed by culturing the samples in specific media, and vitrectomy carries a significantly higher rate of positive results compared to needle sample aspiration [4]. Detection of microorganisms by molecular techniques - polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) has recently emerged as a novel method with superior results compared to cultivation and other laboratory tests (eg. serology), but their introduction in regular practice is yet to occur [1] [2] [5].

Cavitary Lesion
  • She was found to have a pulmonary cavitary lesion and fluffy white material in the anterior chamber. An aqueous and vitreous paracentesis grew Coccidioides species.[ncbi.nlm.nih.gov]
Alternaria
  • Immunodetection was performed using the patient's serum and the following allergens: lemon, Candida, Aspergillus, Penicillium and Alternaria recombinant Alt 1 (Laboratories Diater).[ncbi.nlm.nih.gov]
  • Voriconazole in the management of Alternaria keratitis. Cornea. 2006; 25 (2):242–244. [ PubMed ] [ Google Scholar ] 159. Durand ML, Kim IK, D’Amico DJ, et al.[ncbi.nlm.nih.gov]
Streptococcus Bovis
  • We report a case with bacterial endogenous endophthalmitis caused by Streptococcus bovis, developed after colonoscopy, which had a poor outcome and resulted in evisceration.[ncbi.nlm.nih.gov]
  • The first one was caused by Streptococcus bovis, developed after colonoscopy, which had a poor outcome and resulted in evisceration.[ncbi.nlm.nih.gov]
Salmonella Typhi
  • To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature. Retrospective chart review.[ncbi.nlm.nih.gov]

Treatment

  • Further research into the components of endophthalmitis and its treatment may result in the discovery of new treatment approaches or treatment targets.[ncbi.nlm.nih.gov]
  • METHODS: This is a cross-sectional survey of vitreoretinal specialists regarding indications used for performing a pars plana vitrectomy (PPV), selection of antibiotics for treatment, utilization of cultures, and treatment strategies for treatment-refractory[ncbi.nlm.nih.gov]
  • The patient received antifungal treatment with liposomal amphotericin B and voriconazole, and these conditions were eliminated.[ncbi.nlm.nih.gov]
  • This case highlights the direct choroidal mycobacterial infection of the disease after BCG instillations for bladder cancer and failure of treatment despite culture-proven drug sensitivity, thus suggesting the need to revaluate adequate treatment to avoid[ncbi.nlm.nih.gov]
  • In Group 1, the initial treatment consisted of vitrectomy, intravitreal antibiotics, and silicone oil injection in 19 of 20 patients.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis was poor with 48% demonstrating a visual acuity of LP or NLP at the final follow-up.[ncbi.nlm.nih.gov]
  • S. marcescens endophthalmitis has a poor visual prognosis and may show an in vivo clinical resistance to antibiotic therapy regardless of in vitro culture sensitivities.[journals.lww.com]
  • A suitable and specific treatment with intravenous and intravitreal antibiotics may prevent a bad visual prognosis in some cases.[ncbi.nlm.nih.gov]
  • Fungal endophthalmitis is a rare condition often associated with poor prognosis. We present a case of postoperative acute fungal endophthalmitis caused by the yeast-like fungus Stephanoascus ciferrii (Candida ciferrii).[ncbi.nlm.nih.gov]

Etiology

  • METHODS: All cases diagnosed as endophthalmitis of any etiology and undergoing treatment which progressed to panophthalmitis from January 2005 to December 2015 were included.[ncbi.nlm.nih.gov]
  • Due to its multifactorial etiology, surveillance of such an event is extremely important to identify the causative factor and to prevent recurrences in future.[ncbi.nlm.nih.gov]
  • Moreover, Fusarium is one of the most important etiological agents in exogenous endophthalmitis, which is often favored by the disruption of the epithelial barriers.[ncbi.nlm.nih.gov]
  • RESULTS: In the endophthalmitis group, patients ranged from 5 to 85 years of age and showed varied etiologies. Retinal detachment was present in 5 eyes, which received silicone oil tamponade.[ncbi.nlm.nih.gov]
  • Causative etiology could be microbial contamination of the drug vial. S. maltophilia should be considered a pathogenic organism of postintravitreal endophthalmitis.[ncbi.nlm.nih.gov]

Epidemiology

  • The epidemiology of the disease is very different in Scandinavia compared to Asia. The visual prognosis remains grave and the majority of the eyes lose useful vision.[ncbi.nlm.nih.gov]
  • Because there were only a few case report illustrating endophthalmitis in chronic dialysis patient, we would like to investigate the epidemiology and clinical features of endophthalmitis in chronic dialysis patient in a tertiary referral center.[ncbi.nlm.nih.gov]
  • There are unexpected gems such as an excellent chapter on epidemiology.[nature.com]
  • Discussion of Epidemiology and Treatment: The incidence of post cataract surgery endophthalmitis has varied over the past century.[eyerounds.org]
  • Div of Field Svcs, Epidemiology Program Office, CDC. Editorial Note Editorial Note: Fungal endophthalmitis is a recognized complication of IV-drug use (1). Infection results from hematogenous spread after nonsterile injection (2).[cdc.gov]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Under normal circumstances, the blood-ocular barrier provides a natural resistance against invading organisms.[emedicine.com]
  • Pathophysiology Normally, the blood-ocular barrier prevents invasion from infective organisms but if this is breached (directly through trauma or indirectly due to a change in its permeability secondary to inflammation), infection can occur.[patient.info]
  • Pathophysiology The entry of bacteria into the eye occurs from a breakdown of the ocular barriers. Penetration through the cornea or sclera results in an exogenous insult to the eye.[emedicine.com]

Prevention

  • Systematic collection of data and periodic evaluation of the current practice against the new evidence are necessary to prevent or treat postcataract surgery endophthalmitis.[ncbi.nlm.nih.gov]
  • No systematic review has been performed in English on the role of intravitreal/intracameral antibiotics in preventing traumatic endophthalmitis.[ncbi.nlm.nih.gov]
  • A suitable and specific treatment with intravenous and intravitreal antibiotics may prevent a bad visual prognosis in some cases.[ncbi.nlm.nih.gov]
  • , The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 3 Department of Infection Control and Prevention, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 4 Department of Ophthalmology, The[ncbi.nlm.nih.gov]

References

Article

  1. Vaziri K, Schwartz SG, Kishor K, Flynn HW Jr. Endophthalmitis: state of the art. Clin Ophthalmol. 2015;9:95-108
  2. Safneck JR. Endophthalmitis: A review of recent trends. Saudi J Ophthalmol. 2012;26(2):181-189.
  3. Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol. 2010;4:121-135.
  4. Durand ML. Endophthalmitis. Clin Microbiol Infect. 2013;19(3):227-234.
  5. Sadiq MA, Hassan M, Agarwal A, et al. Endogenous endophthalmitis: diagnosis, management, and prognosis. J Ophthalmic Inflamm Infect. 2015;5:32.

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Last updated: 2019-06-28 12:10