Ophthalmology Book

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Endophthalmitis

Aka: Endophthalmitis, Endogenous Endophthalmitis, Endogenous Bacterial Endophthalmitis
  1. See Also
    1. Acute Red Eye
  2. Definitions
    1. Endophthalmitis
      1. Purulent inflammation of the vitreus humor and Aqueous Humor
      2. Typically due to eye infection but may also occur with signficant Eye Trauma (e.g. Mechanical Globe Injury)
  3. Pathophysiology
    1. Typically due to Bacterial eye infection
      1. Coagulase negative Staphylococcus is the most common organism
      2. Endogenous Endophthalmitis, a hematogenous spread from other sites may also rarely occur (see below)
    2. Post-Traumatic Endophthalmitis
      1. May also be caused by Bacillus and Streptococcus species
  4. Causes
    1. Corneal Injury
    2. Corneal infection (Keratitis)
    3. Eye surgery
      1. Acute Post-Cataract Endophthalmitis (75% present in first week, may occur up to 6 weeks after surgery)
      2. Glaucoma filtering surgery
    4. Endogenous Endophthalmitis
      1. Rare Hematogenous spread of infection from other sites (e.g. Urinary Tract Infection)
      2. Risk factors include Alcoholism, Diabetes Mellitus and Cardiovascular disease
  5. Differential Diagnosis
    1. Keratitis
    2. Conjunctivitis
    3. Uveitis
  6. Symptoms
    1. Severe Eye Pain
    2. Acute Vision Loss (over prior 24 hours)
  7. Signs
    1. Typically afebrile
    2. Eyelid Swelling
    3. Decreased Visual Acuity
    4. Visual Floaters
    5. Conjunctival injection, edema and hyperemia
    6. Corneal haziness or clouding
    7. Hypopyon
    8. Anterior chamber cells and flare (Iritis)
    9. Pupil abnormality
  8. Management
    1. Intravenous Antibiotics
    2. Emergent ophthalmology evaluation
      1. Aspiration of Aqueous Humor and vitreous humor for Gram Stain and culture
        1. A negative culture does not exclude Bacterial Infection
      2. Intravitreal antibiotic injection
      3. Vitrectomy in cases of severe Vision Loss (patient only maintains light Perception)
      4. Corticosteroids and cyloplegics may be indicate in some cases
  9. Prognosis
    1. Recovery to 20/40 Vision in 50% of cases
    2. Chronic loss of useful Vision in 10% of cases
  10. References
    1. Trobe (2012) Physician's Guide to Eye Care, AA0, p. 70
    2. Sales, Patel and Patel (2019) Crit Dec Emerg Med 33(12): 3-13
    3. Sadiq (2015) J Ophthalmic Inflamm Infect 5(1):32 +PMID: 26525563 [PubMed]

Endophthalmitis (C0014236)

Definition (MSH) Suppurative inflammation of the tissues of the internal structures of the eye frequently associated with an infection.
Definition (MSHCZE) Akutní zánět všech nitroočních tkání a struktur, větš. vznikající z exogenních příčin (zanesení infekce např. při traumatu nebo nitroočním chirurgickém výkonu), řidč. je metastatického původu. Vyvolavateli mohou být četné bakterie, plísně, ev. ricketsie a paraziti. Projevuje se poruchou zraku, krutými bolestmi, celkovými příznaky a rozsáhlým patologickým nálezem na oku (otok, zarudnutí, chemóza spojivek, zkalení komorové vody), protruzí a omezenou motilitou bulbu atd. Velmi závažný stav, který i přes intenzivní léčbu končí oslepnutím. Provádí se intenzivní celková i lokální léčba antibiotiky a chirurgický zákrok (vitrektomie, eviscerace bulbu). Jako fakogenní e. se označuje zánět vzniklý na základě autoimunitního procesu např. po extrakci čočky s ponechanými zbytky tkáně. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) An infectious process affecting the internal structures of the eye.
Definition (NCI_CTCAE) A disorder characterized by an infectious process involving the internal structures of the eye.
Concepts Disease or Syndrome (T047)
MSH D009877
SnomedCT 123052006, 82255004, 128295000, 1847009
English Endophthalmitides, Ophthalmia, Ophthalmias, endophthalmitis (diagnosis), endophthalmitis, Endophthalmitis, Eye inflammation NOS, Endophthalmitis [Disease/Finding], eye inflammations, inflammation eye, Inflammation;eye, eye inflammation, ophthalmia, eyes inflammation, Ophthalmitis (disorder), Eye inflammation, Eye--Inflammation, ENDOPHTHALMITIS, Ophthalmitis, Endophthalmitis (disorder), Inflammatory disorder of the eye (disorder), Inflammatory disorder of the eye, disease (or disorder); eye, inflammatory, eye; disorder, inflammatory, Endophthalmitis, NOS, Ophthalmia, NOS, Ophthalmitis, NOS, Ophthalmitis -RETIRED-, inflammation of the eye
Portuguese ENDOFTALMITE, Oftalmite, Inflamação ocular NE, Inflamação dos olhos, Endoftalmite, Oftalmia
Spanish ENDOFTALMITIS, Inflamación del ojo NEOM, Oftalmitis, oftalmía, oftalmitis - RETIRADO -, oftalmitis - RETIRADO - (concepto no activo), endoftalmitis (trastorno), endoftalmitis, oftalmitis, trastorno inflamatorio del ojo (trastorno), trastorno inflamatorio del ojo, trastorno ocular inflamatorio, Inflamación ocular, Endoftalmitis, Oftalmía
German ENDOPHTHALMITIS, Augenentzuendung NNB, Ophthalmitis, Augenentzuendung, Endophthalmitis, Augenentzündung
French Inflammation de l'oeil, Inflammation oculaire SAI, Ophtalmite, ENDOPHTALMIE, Ophtalmie, Endophtalmie
Italian Infiammazione oculare, Oftalmite, Infiammazione oculare NAS, Oftalmia, Endoftalmite
Dutch oogontsteking NAO, oftalmie, aandoening; oog, inflammatoir, oog; aandoening, inflammatoir, endoftalmitis, oogontsteking, Endoftalmitis, Oftalmie
Japanese 眼の炎症ＮＯＳ, 眼の炎症, 眼球炎, ﾒﾉｴﾝｼｮｳNOS, ｶﾞﾝｷｭｳｴﾝ, ﾒﾉｴﾝｼｮｳ, ｶﾞﾝﾅｲｴﾝ, 眼内炎, 眼炎, 内眼球炎
Swedish Endoftalmit
Czech endoftalmitida, Zánět oka, Zánět oka NOS, Oftalmitida, Endoftalmitida
Finnish Endoftalmiitti
Russian ENDOFTAL'MIT, OFTAL'MIIA, ОФТАЛЬМИЯ, ЭНДОФТАЛЬМИТ
Croatian ENDOFTALMITIS
Polish Zapalenie gałki ocznej wewnętrzne
Hungarian Szem gyulladás, Szem gyulladás k.m.n., Ophthalmitis, Endophthalmitis
Norwegian Endoftalmitt, Oftalmi
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Endogenous endophthalmitis (C1282231)

Concepts Disease or Syndrome (T047)
SnomedCT 314548006
English endophthalmitis endogenous (diagnosis), endophthalmitis endogenous, Endogenous endophthalmitis (disorder), Endogenous endophthalmitis
Spanish endoftalmitis endógena (trastorno), endoftalmitis endógena
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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