Download MBBS 3rd Year Ophthalmology Endophthalmitis Topic Notes

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 3rd Year (Third Year) Ophthalmology Endophthalmitis Topic Handwritten Notes

DEFINITION
? Inflammation of the inner structures of eyebal , i.e, uveal tissue and
retina associated pouring of exudates in the vitreous cavity
,anterior chamber and posterior chamber

ETIOLOGY
A . Infective endophthalmitis ?
Modes of infection ?
1.Exogenous infections ?perforating injuries, perforation of infected
corneal ulcers ,or as postoperative infections following intraocular
operations
2.Endogenous or metastatic endophthalmitis ? through blood stream
from infected in the body such as caries teeth, septicaemia,
puerperal sepsis
3.Secondary infections from surrounding structures- from orbital
cellulitis, thrombophlebitis and infected corneal ulcers

CAUSATIVE ORGANISMS
? Bacterial endophthalmitis- staphylococcus epidermidis and s. aureus. Other
causative bacteria include Streptococci, Pseudomonas, Pneumococci,
Corynebacterium. Propionibacterium acnes and Actinomycetes- produce slow
grade endophthalmitis
? Fungal endophthalmitis- occur after intraocular surgery or injury with
vegetative matter such as thorn or wood stick. Organisms causing are
Aspergillus, Fusarium, Candida.



NON INFECTIVE ENDOPHTHALMTIS
? IT IS STERILE. Caused by reaction to certain toxins/toxic substances
1.Postoperative sterile endophthalmitis ?IOL, instruments, toxic
anterior segment syndrome
2.Post traumatic sterile endophthalmitis?reaction to retained
intraocular foreign body
3.Phacoanaphylactic endophthalmitis-
4.Intraocular tumour necrosis

CLINICAL FEATURES
? It is a catastrophic complication of intraocular surgery (0.1%)
? Source of infection- patients own periocular bacterial flora, contaminated
solutions and instruments, environmental flora
? Onset ? acute or delayed
? Acute onset- bacterial cause , between 1-7 days of operation
? Delayed onset ? 1 week to month after surgery. Fungi are the most
common cause. Propionibacterium also cause this.


SYMPTOMS
? Severe ocular pain
? Redness
? Lacrimation
? Photophobia
? Loss of vision

SIGNS
1.LIDS -red and swollen
2.Conjunctiva shows chemosis,marked CCC
3.Cornea is oedematous ,cloudy, ring infiltration may be formed
4.Edges of wound become yellow and necrotic wound may gape
5.Anterior chamber shows hypopion
6.Iris is oedematous and muddy
7.Pupil- yellow reflex d/t purulent exudation in the vitreous


? Vitreous exudation ? with pus .yellowish white mass is seen through the fixed
dilated pupil . (amaurotic cat`s eye reflex)
? Intraocular pressure- raised in early stages,later IOP wil decrease shrinkage of the
globe occurs


MANAGEMENT
? INVESTIGATIONS ? detailed history , ocular examination and USG
? By demonstrating exudates in the vitreous
? Vitreous tap or biopsy is needs to be performed and aspirate examined by
GRAM AND GIEMSA STAIN
? Bacterial and fungal cultures
? KOH mount for fungal elements
? CBC ,RBS,serum eletrolytes

TREATMENT
? Early diagnosis and vigorous therapy
? Antibiotic therapy ?
1.Intravitreal antibiotics and diagnostic tap
should be performed aeap. Through
transconjunctival y under topical anaesthesia from the area of pars plana. using a 23 guage
needle (vitreous tap) fol owed by a intravitreal inj.of antibiotics using a 30 guage needle .it is
the mainstay of trt.
Usual y combination two antibiotics .
First choice ?
vancomycin 1mg in 1ml plus ceftazidime
Second choice ?vancomycin 1mg in 0.1ml plus amikacin 0.4mg in 0.1 ml

? We can add dexamethasone 0.4 mg in 0.1 ml to limit postinflammatory responses
? If there is no improvement repeat inj after 48 hours acc to bacteriological examination
2. Topical concentrated antibiotics should be started immediately and used frequently
Vancomycin 50mg/ml or cefazolin 50mg/ml
Amikacin 20mg/ml or tobramycin 15mg/ml
3. Systemic antibiotics ? have only a limited role . Ciprofloxacin ,vancomycin and ceftazidime,
cefazolin and amikacin

? Steroid therapy- limit the tissue damage caused by infl process
? Intravitreal inj of dexamethasone 0.4mg in 0.1ml along with antibiotics
? Topical use of dexa(0.1%) or predacetate(1%)
? Systemic steroids- prednisolone

? Supportive therapy ?
1. Cycloplegics ?preferably 1%atropine or 2%homatropine eyedrops TDS OR QID
2. Antiglaucoma drugs ? oral acetazolamide or timolol
? Vitrectomy ? if there is no improvement after intensive therapy for 48 to 72 hours

This post was last modified on 11 August 2021