Overview

Endophthalmitis is a serious and potentially vision-threatening condition characterized by inflammation inside the eye, usually involving the vitreous and aqueous humor. It is most commonly caused by an infection, either bacterial or fungal, following eye surgery, trauma, or eye injections. Prompt diagnosis and treatment are crucial to prevent permanent vision loss or damage to the eye. Although endophthalmitis is relatively rare, it is considered a medical emergency due to its rapid progression and risk of blindness if untreated.

Causes

Endophthalmitis can be classified based on its origin:

• Exogenous Endophthalmitis: The most common type, caused by external contamination entering the eye, usually after:
  • Eye surgeries, especially cataract surgery.
  • Intravitreal injections (for conditions like macular degeneration).
  • Eye trauma or penetrating injuries.
• Endogenous Endophthalmitis: Occurs when an infection spreads to the eye through the bloodstream from other infected areas of the body. It is less common but more difficult to treat.
• Microbial Causes:
  • Bacterial: The most frequent cause, especially following surgery or trauma.
  • Fungal: More common in immunocompromised individuals or after certain surgeries or injections.

Symptoms

Symptoms of endophthalmitis usually develop rapidly and may include:

• Severe eye pain, often sudden in onset.
• Decreased vision or sudden vision loss.
• Redness of the eye.
• Swelling of the eyelids and surrounding tissues.
• Increased sensitivity to light (photophobia).
• Cloudiness or white spots visible in the pupil (hypopyon).
• Discharge from the eye, particularly in bacterial infections.

Diagnosis

Prompt diagnosis of endophthalmitis involves several steps to quickly identify the cause and begin treatment:

• Clinical examination: An ophthalmologist performs a slit-lamp examination to assess inflammation and abnormalities in the anterior and posterior segments of the eye.
• Ocular ultrasound: Helpful when visibility inside the eye is obscured by inflammation or opacities.
• Vitreous or aqueous tap: Samples of intraocular fluid are taken and sent for laboratory testing to identify bacterial or fungal organisms.
• Blood cultures: Especially in cases of endogenous endophthalmitis to identify systemic infections.
• Imaging tests: May be used in cases where systemic infection is suspected.

Treatment

Treatment for endophthalmitis needs to be started immediately and typically includes:

• Intravitreal antibiotics or antifungals: Direct injections of powerful medications into the eye to fight infection.
• Systemic antibiotics: Oral or intravenous antibiotics are used in some cases, especially with endogenous endophthalmitis.
• Topical eye drops: Antibiotics, steroids, and anti-inflammatory drops may be used to reduce surface inflammation and pain.
• Vitrectomy surgery: In severe or non-responsive cases, surgical removal of the vitreous gel may be required to clear infection and improve vision outcomes.
• Pain management: Analgesics may be prescribed to manage eye pain during recovery.

Prognosis

The prognosis of endophthalmitis depends on the speed of diagnosis, type of causative organism, and promptness of treatment. Early treatment generally leads to better visual outcomes, especially in cases caused by less aggressive bacteria. However, severe infections, fungal causes, or delays in treatment can result in poor vision or even complete blindness.

With timely intervention, some patients may recover partial or significant vision, though permanent vision impairment is still possible. Preventive measures, including sterile surgical techniques and proper eye care post-surgery or trauma, are essential to reduce the risk of endophthalmitis. Regular follow-ups with an ophthalmologist are critical during recovery to monitor progress and prevent complications.