Endophthalmitis: Symptoms and Treatment

Endophthalmitis is an ailment that is characterized by the formation of an inflammatory process in the internal structures of the eye, which causes the accumulation of purulent fluid. This disorder requires immediate medical attention.



There are many factors that can cause the development of such a dangerous disease, why they are divided into several large groups — external and internal. In any case, the ailment leads to the development of severe complications.

Among the clinical signs, pain comes from the side of the affected eye, puffiness and redness of the eyelids, as well as a decrease in visual acuity.

To make the correct diagnosis, an ophthalmologic examination and instrumental examination will be required. Tactics of therapy are made individually for each patient, because it will vary depending on the severity of the disease.

Etiology

As stated above, both external and internal factors can lead to the formation of the disease. The first group of reasons include:


  • a penetrating wound in the eye — is the most common source of external infection, which accounts for 95% of the total number of cases of this disease
  • previous surgical procedures on the eyes
  • perforation of the purulent corneal ulcer
  • eye burns with chemical, toxic and other dangerous substances
  • penetration into the eye of a foreign object.

The group of internal causes is characterized with penetration and pathological influence of pathogens. This can happen against a background:


  1. the formation of a furuncle or abscess
  2. sepsis and osteomyelitis
  3. phlegmon and sinusitis
  4. tonsillitis;
  5. meningitis, etc.

Both under the influence of exogenous factors and under the influence of endogenous causes, the causative agents of such a disease can be:


  • Staphylococcus or streptococci
  • Proteus or haemophilus rod
  • Corynebacteria or enterobacteria
  • Neisseria or pneumococci
  • Klebsiella or Pseudomonas aeruginosa

In general, endophthalmitis can cause more than twenty pathogens, as well as various bacterial associations. In addition, the ailment can cause fungus, in particular:


  1. candidates;
  2. Aspergillus
  3. Neurospores
  4. Cephalospirium

Classification

Depending on the prevalence of the inflammatory process, the endophthalmitis of the eye happens:


  • focal — characterized by local changes in the site of penetration of the infectious agent. This means that only part of the gas is involved in the pathological process. This type of inflammation can be of two degrees of severity. Light — accompanied by a slight turbidity of the vitreous, but the vision is still preserved, but slightly reduced. Heavy — involves melting the shells of the eye, which leads to a significant loss of vision;
  • diffuse — the changes caused by inflammation spread to the entire vitreous body, which is expressed in its total opacity;
  • mixed — is such in cases when against a background of total inflammation there is a limited zone on which the vitreous body melts.

In addition, distinguish between acute and chronic course of the disease. The second is considered as such if the inflammation develops not earlier than six weeks after infection.

Symptoms

The basis of the clinical picture is the pain syndrome, against which the following symptoms of endophthalmitis may develop:


  1. redness and swelling of the lower and upper eyelid
  2. the appearance on the lower edge of the iris of a strip that has a white or yellow hue. This is a congestion of purulent or fibrous fluid;
  3. reducing visual acuity — from a slight vagueness of the picture to total loss
  4. increased lachrymation of the affected eye
  5. pain spread to the whole head

Very rarely the following symptoms can be noted:


  • Iris color change;
  • pupil deformation;
  • increase in intraocular pressure
  • the appearance of a yellowish patch in the pupil — this indicates an abscess formation
  • profuse suppuration

In some cases endophthalmitis is bilateral.




Diagnostics

To make a correct diagnosis, you will need to perform a large number of instrumental examinations, but before performing them, an ophthalmologist needs to:


  1. thoroughly interview the patient for the first time of onset and severity of symptomatic manifestations
  2. study the medical history and collect an anamnesis of the patient’s life
  3. conduct a thorough ophthalmologic examination, which includes assessing visual acuity and measuring intraocular pressure.

Performing laboratory tests of blood, urine and feces with endophthalmitis is not diagnostic.

Among the instrumental examinations are:


  • The ultrasound of the affected eye
  • Biomicroscopy
  • diaphanoscopy;
  • direct and reverse ophthalmoscopy;
  • Electroretinography

Treatment

After confirming the diagnosis, the patient’s endophthalmitis is sent to the surgical ophthalmology department. Immediately after this, shock doses of antibiotics are prescribed.

In addition, there is a powerful detoxification, resorption and restorative therapy.

For the concentration of antibacterial substances inside the eye to be maximum, they can be assigned:


  1. intravenously
  2. intramuscularly
  3. subconjunctival;
  4. retrobulbarno — through the skin of the lower eyelid
  5. parabulbar — drugs are injected into the area between the eyeball and periosteum;
  6. Suprachoroidal
  7. intravitreal — the injection is injected directly into the affected eye.

In cases of ineffectiveness of conservative therapy of endophthalmitis surgical — vitrectomy is shown.

Complications

Late application for qualified care is fraught with the following complications:


  • Adhesive process
  • formation of abscess;
  • purulent panophthalmitis
  • total loss of vision;
  • meningitis or encephalitis

Prevention and Forecast

In order to avoid problems with the appearance of such a dangerous disease as endophthalmitis, it is necessary: ​​


  1. remove foreign objects from the eye in a timely manner
  2. Avoid injury to the organs of vision
  3. Regularly undergo examinations with an ophthalmologist




Timely detection and complex therapy provides a favorable prognosis, i.e., preservation of vision. The severe course of the disease quite often leads to the formation of severe complications.