Endophthalmitis is inflammation of the eye of infectious origin. Most of the time, the infection is caused by microorganisms infiltrated through a surgical incision or damage to the eyeball. Endophthalmitis is often manifested by severe pain in the eye, visual impairment, and / or extreme sensitivity to light. The infection is treated by taking antibiotics, antifungals and / or corticosteroids. In some cases, surgical removal of the vitreous is recommended.

Endophthalmitis is inflammation of the eye of infectious origin. When it occurs following an operation, endophthalmitis is said to be acute when it sets in during the first postoperative week. The subacute form extends from the second to the end of the fourth postoperative week while the chronic form begins after the first month. Thus, postoperative endophthalmitis is almost always considered a nosocomial infection.

Causes

Most of the time, endocular infection is caused by microorganisms infiltrated through a surgical incision or injury to the eyeball. More rarely, these microorganisms can reach the eye through the blood. In this case, the infection of the blood can be caused by dental surgery, intravenous injection of drugs, abscess, skin ulcers, infections (pneumonia, sepsis).

Most cases of endophthalmitis are caused by gram-positive bacteria, such as Staphylococcus epidermidis ou S. aureus. Endophthalmitis caused by Gram negative organisms tends to be more virulent and has a poorer prognosis. Finally, endophthalmitis can also be caused by fungi or protozoa.

Diagnostic

The diagnosis requires careful attention in any patient at risk, especially in recent trauma or eye surgery. It is initially based on the observation of symptoms and an ophthalmological examination.

The doctor systematically performs several additional examinations:

• Gram stain: laboratory technique that identifies bacteria based on their shape, size and affinity with different dyes.
• Culture of samples from the anterior chamber and vitreous

Any patient suspected of endogenous endophthalmitis should also undergo:

• A blood culture: inoculation of samples taken from the eye on culture media suitable for the search for a pathogenic germ
• A cytobacteriological examination of the urine (ECBU)

The people concerned

When endophthalmitis is of exogenous origin, it occurs in 0,07% to 0,32% of cataract surgeries.

Risk factors

During cataract surgery, the incidence of endophthalmitis is quadrupled in case of secondary implantation, in case of capsular rupture (a complications of the operation) and in diabetics.

Even if they are not present in every case, three symptoms are warning signs to be taken seriously, especially following cataract surgery:

• Pain increasing in intensity
• A drop in visual acuity
• Photophobia: extreme sensitivity to light

Other symptoms

• Loss of retinal reflection (red reflection)
• Hypopion: presence of pus in the anterior chamber of the eye (space between the iris and the innermost surface of the cornea)
• Disorder of aqueous humor (the fluid in the anterior chamber of the eye)
• Increased intraocular pressure
• Eye redness around the cornea
• Cellular deposits in the intraocular lens deposited during surgery
• Retinal hemorrhage
• Conjunctival hyperemia: accumulation of blood in the vessels of the conjunctiva, the mucous membrane that covers the inside of the eyelids
• Intraocular inflammation in the anterior chamber and vitreous
• Edema of the eyelid and / or cornea
• Presence of fibrin (a protein in blood plasma that helps form a clot) in the anterior chamber of the eye
• Exophthalmos: protrusion of the eyeball out of the orbit
• Petechiae (small purplish red spots) of the iris
• Ptosis: fall of the upper eyelid
• Epiphora: discharge of tears on the cheeks, in cases where they cannot pass through the tear points.
• Fever, nausea, fatigue

Initial treatment includes:

• An intravitreal injection of broad-spectrum antibiotics, most often vancomycin (reference product for gram-positive bacteria) and ceftazidime (against grams-negative). Along with antibiotics, corticosteroids such as dexamethasone can be injected. Infections with a fungus are treated with antifungals, including Fungizone.
• The patient with endogenous endophthalmitis should be given antibiotics in the eye or intravenously. The choice of antibiotic therapy is then adapted according to the pathogens identified.

Vitrectomy (surgical removal of the vitreous body) with injection of intraocular corticosteroids should be considered in patients whose vision is already severely impaired at the time of diagnosis. Surgery removes infected tissue, which increases the chances of stopping the infection.

During intraocular surgery, prevention of endophthalmitis involves taking care of asepsis and antisepsis.

To limit the irreversible consequences on vision, endophthalmitis should be considered a medical emergency because the visual prognosis is directly related to the time interval between the appearance of the infection and its treatment. In extreme cases, a delay of a few hours can even cause irreversible vision loss.