Endophthalmitis is an inflammation of the inside of the eye. It is caused by infections in the eye.
What is endophthalmitis?
Endophthalmitis is an extremely rare condition, but one that is feared for its serious consequences. In the United States, approximately 1200 cases of endophthalmitis occur per year after surgery. The incidence in Germany after cataract surgery is about 0.08 percent. The condition can occur even with minor surgery. In endophthalmitis, an inflammatory reaction occurs inside the eye. This inflammation is usually caused by an infection with microorganisms. In contrast to panophthalmitis, the inflammation only affects the interior of the eye and not the entire eye. In exogenous endophthalmitis, a distinction can be made between an exogenous and an endogenous form. In endophthalmitis, the pathogens enter the eye from the outside. Endogenous endophthalmitis is associated with the spread of the germs via the bloodstream. The main symptom of endophthalmitis is dull pain and visual disturbances. The prognosis of endophthalmitis is extremely unfavorable. In extreme cases, the eye must be removed.
Causes
Endophthalmitis is caused by microorganisms. In an exogenous infection, the pathogens enter the eye through injuries. For example, exogenous endophthalmitis can occur after eye surgery under nonsterile surgical conditions. Exogenous endophthalmitis is the more common form. Endogenous endophthalmitis occurs less frequently. Here, the infection originates in another organ. The pathogens spread through the body via the bloodstream. This process is also known as sepsis or blood poisoning. Sepsis is usually caused by bacteria. It occurs as a result of surgical complications, eye injuries, and in immunocompromised patients such as diabetics or AIDS patients. Bacteria, viruses and parasites are possible causative agents of endophthalmitis. Among bacteria, enterococci, Klebsiella pneumoniae, Bacillus spp, Proteus spp, streptococci, staphylococci, mycobacteria, and Treponema pallidum are possible causative agents. Candida albicans and other Candida species, Aspergillus spp, Mucor species, Penicillium, and Blastomyces dermatitidis are fungi that can cause infection of the interior of the eye. Other possible pathogens include human cytomegalovirus, herpes simplex virus, measles virus, rubella virus, and varicella zoster virus. Parasites that can cause endophthalmitis include Taenia solium, Toxoplasma gondii, and Toxocara canis (canine roundworm).
Symptoms, complaints, and signs
Dull and severe pain in the eye is typical of endophthalmitis. Vision deteriorates massively and there is severe sensitivity to light (photophobia). The eyelids are swollen. In medical terminology, this phenomenon is called eyelid edema. There is increased blood flow to the conjunctiva. This conjunctival hyperemia is noticeable by redness of the eyes. Not only the eyelids, but also the conjunctivae may be swollen. Edema of the conjunctiva is called chemosis. In this case, the conjunctiva stands out like a bubble from the sclera. The cornea is also swollen. Water is deposited in the stroma of the cornea. As a result, the arrangement of the collagen lamellae in the cornea is disturbed and the thickness of the cornea increases. As a result, the transparency of the cornea is reduced and it appears milky-cloudy. There is a deterioration of vision with circular appearances around light sources (halos). A characteristic phenomenon of endophthalmitis is the Tyndall phenomenon. This is a clouding of the aqueous humor caused by increased levels of inflammatory cells and proteins. Furthermore, pus may form in the anterior chamber of the eye (hypopyon). During backlight tests, the pupils light up whitish. This phenomenon is also called leukocoria. In addition, the vitreous may be infiltrated and cloudy. In contrast to panophthalmitis, in endophthalmitis only the inner parts of the eye are affected. The shell of the eye is free of inflammation.
Diagnosis
If endophthalmitis is suspected, an ultrasound examination is performed. This is followed by pathogen detection from the aqueous humor and vitreous humor. Pathogen identification is important for therapy.Endophthalmitis can be caused by many different pathogens, so pathogen identification is necessary to choose the appropriate drug.
Complications
Fast action is required for endophthalmitis. Depending on which pathogen has triggered the endophthalmitis in the specific case, different medications are used. In the case of a bacterial infection, these are antibiotics that are given both locally on the eye (for example, as drops or as a cream around the eye) and as part of a systemic therapy. The high-dose antibiotic used in a systemic combination can lead to side effects, such as severe fatigue, malaise, severe diarrhea, or partial destruction of the intestinal flora. When penicillin is administered, allergic reactions are common, ranging from skin irritation to allergic shock. If endophthalmitis remains untreated, the inflammation spreads very quickly. Because of the severe damage to the eye, untreated endophthalmitis leads to complete loss of vision, sometimes to loss of the entire eye. Another complication indirectly related to endophthalmitis can be seen in the development of resistance by the pathogens. In the case of resistance, bacteria can no longer be treated with current antibiotics. Resistance leads to the fact that bacterially caused diseases – and thus also endophthalmitis – can be treated more and more poorly.
When should you see a doctor?
If there are changes in the usual vision, there is reason to be concerned. If there is sensitivity to light or decreased vision, a doctor should be consulted. If a headache sets in or a feeling of pressure is felt inside the head, a doctor’s visit is necessary. Before taking pain medication, it is necessary to consult a physician to clarify possible risks and side effects. In case of swollen or watery eyes as well as itching in the eye, a doctor should be consulted. Discoloration of the skin in the eye area or on the retina is considered unusual and should be medically examined. If the cornea swells, a doctor’s visit should be made as soon as possible. Clouding of the eye or milky discoloration should be presented to and examined by a physician. If pus forms, the risk of blood poisoning increases. A doctor’s visit is necessary to prevent a life-threatening condition from developing. If there are emotional problems, a doctor’s visit is also necessary. If anxiety or behavioral problems occur, a doctor or therapist should be seen. Aggressive or hysterical behavior is cause for concern and should be discussed. If there is a decrease in performance, disturbances in concentration or inner restlessness, consultation with a physician is recommended.
Treatment and therapy
Bacterial endophthalmitis is treated with antibiotics. These can be administered as eye drops, for example. Intravenous antibiotic administration or injections of antibiotics into or around the eye are also possible. Possible antibiotics for the treatment of endophthalmitis include cefazolin, ceftazidime, penicillin, vancomycin, clindamycin, ampicillin, and oxacillin. Local therapy to the eye is supplemented by high-dose systemic therapy. If necessary, supplemental glucocorticoids are used. However, if the endophthalmitis is caused by fungi, glucocorticoids are contraindicated. In severe cases, surgical intervention on the vitreous body, a so-called vitrectomy, may be necessary. The prognosis is highly dependent on the virulence of the pathogen. The duration of the infection also plays a role. Frequently, the damage to the retina leads to a loss of function of the eye. In very severe cases, the eye must be completely removed during enucleation.
Outlook and prognosis
If left untreated, endophthalmitis has an unfavorable prognosis. The triggering bacteria can multiply unhindered in the organism and continue to spread. As a result, symptoms steadily increase until the affected person’s vision is completely impaired. The prospect of recovery improves with the use of optimal and timely medical care. The administration of medication leads to a regression of the symptoms in most patients. Within a few days, significant improvements in health are already apparent.Vision increases until, after a few weeks, the patient is normally free of symptoms. The patient is discharged from treatment as symptom-free as soon as vision is fully restored and the swelling of the eyes has subsided. In rare cases, complications develop in patients with the disease. If the agents do not show sufficient efficacy, the prognosis worsens. In case of resistance to the preparations, the pathogens can continue to multiply and spread in the organism. This leads to a chronic or progressive course of the disease, which promises little improvement. In addition, there is a risk of blood poisoning or psychological impairment. In the case of sepsis, a fatal course may occur. With mental disorders, the overall prognosis is worsened by another.
Prevention
In most cases, endophthalmitis is the result of eye surgery. The condition can be prevented by sterile surgical conditions. If pain occurs in the operated eye after surgery, a physician should be consulted immediately. The earlier endophthalmitis is treated, the better the prognosis. However, patients with a weakened immune system may be affected even without surgery. Prevention of the disease is hardly possible in this case.
Aftercare
In most cases of endophthalmitis, there are no direct options or measures of aftercare available to the patient. Therefore, the primary concern with this condition is early detection and treatment of the symptoms to prevent further infections or other complications. If endophthalmitis is detected late, in the worst case it can also lead to complete blindness of the affected person, which can no longer be treated. As a rule, the disease is treated with the help of medication, including antibiotics. The affected person should always take the medication prescribed by the doctor in order to alleviate the symptoms. In most cases, the symptoms disappear after a few days. If the symptoms of endophthalmitis do not disappear again with the help of antibiotics, another visit to a doctor is usually necessary. When taking antibiotics, it is also important not to take them together with alcohol, as this can significantly reduce their effect. Support from friends and family is also very important. In this regard, especially loving and intensive care has a positive effect on the course of endophthalmitis.
What you can do yourself
If endophthalmitis has been diagnosed, local therapy with antibiotics is indicated. The individual symptoms can be alleviated with the help of some self-help measures and remedies from the household and nature. Cooling compresses and face masks help against swollen eyelids. Eyelid edema can also be relieved by avoiding irritating environmental factors such as wind and excessive sun exposure. Similar measures reduce swelling of the conjunctiva and help speed recovery. If the cornea is also swollen, strict hygiene measures should be observed. Further irritation by care products or pathogens must be avoided at all costs to rule out secondary diseases. For skin care, applications with chamomile, lemon balm and other natural remedies are recommended. If vision has already deteriorated, a visual aid must be worn. The patient should consult an ophthalmologist at an early stage to prevent further deterioration of vision. If there is pus formation in the anterior chamber of the eye, a visit to the doctor is necessary. Also, in case of serious complaints that cannot be alleviated by mentioned measures, it is best to consult a medical doctor. Although endophthalmitis usually heals without complications, the therapy must be well monitored.
