Endoftalmitis: symptoms, causes and treatment

Definition of endophthalmitis

Endoftalmitis is a severe inflammation that occurs in the inner tissue of the eye. This inflammation occurs in the vitreous and aqueous humor .

Vitreous is a clear gel-like substance located in the center of the eyeball, precisely behind the lens of the eye. Meanwhile, aqueous humor is a clear liquid that coats the front of the eye.

Inflammation is usually caused by a bacterial infection (eg Staphylococcus , Streptococcus , and gram-negative bacteria) or fungi (such as Candida and Aspergillus).

Although very rare, this condition can also be caused by viral infections (herpes simplex or herpes zoster) or protozoa (such as Toxocara, Toxoplasma).

Sterile (non-contagious) endophthalmitis can also result from a broken lens left in the eye after cataract surgery or drugs that are injected into the eye.

In general, endophthalmitis is a condition that can be divided into 2 types, namely endogenous and exogenous.

Endogenous types are generally caused by infections that have occurred in other parts of the body and passed to the eye via the bloodstream. Meanwhile, exogenous types occur due to infection or other causes from outside the body, such as after surgery or trauma to the eye.

How common is this condition?

Endoftalmitis is a rare eye disease. The incidence rate is estimated to be only around 2-15%. The average annual rate is about 5 in 10,000 hospitalized patients.

In the case of unilateral endophthalmitis, aka only one eye is affected, the right eye is much more susceptible to infection than the left eye. This is probably due to the location of the arteries and carotid arteries.

People who have had eye surgery, such as cataracts and glaucoma, are more prone to developing this condition. However, this condition can be overcome by reducing risk factors.

Symptoms of endophthalmitis

The most common signs and symptoms of endophthalmitis are vision loss and pain in the eye. Depending on the cause, signs and symptoms may vary.

Early symptoms of endophthalmitis can include:

• Drastic decrease in vision
• Pain in the eye that gets worse after surgery
• Red eye
• Swollen eyelids
• More sensitive to light

If you have the post-traumatic (exogenous) type, some of the signs and symptoms of endophthalmitis that may appear are:

• Drastic reduction in vision
• Pain in the eye that gets worse after surgery
• Red eye
• Swollen eyelids

If the eye inflammation you suffer is from an infection in the body (endogenous), the signs and symptoms will appear gradually, such as:

• Vision decreases slowly over a few weeks
• Appear floaters , namely dark, semi-transparent patches that interfere with your vision

There may be signs and symptoms not listed above. If you have concerns about a particular symptom, consult your doctor.

When should I see a doctor?

Endoftalmitis is an emergency condition that can cause permanent vision loss if not diagnosed or treated promptly.

You should contact your doctor if you have the above signs and symptoms or any other questions, especially if you have or have had:

• Eye surgery
• Eye trauma
• Conditions that weaken your body's immune defenses

Each sufferer's body shows signs and symptoms that vary. To get the most appropriate treatment and according to your health condition, immediately consult a doctor if unusual symptoms appear.

Causes of endophthalmitis

As previously explained, endophthalmitis is a condition that is divided into two types, namely exogenous and endogenous.

Apart from the two types, there is endophthalmitis which occurs less frequently, namely phacoanafylactic. Here's the explanation.

1. Exogenous Endoftalmitis

Exogenous endophthalmitis is caused by an infection that comes from outside the body. The exogenous type of inflammation is the most common.

This condition is generally caused by improper surgical procedures. Bacterial or fungal infections can enter through the wound during surgery.

Quoted from the American Society for Microbiology, most cases of exogenous endophthalmitis occur as complications of cataract surgery, intravitreal injections, or penetrating eye trauma.

2. Endogenous endogenous endogenous

Another type of endophthalmitis is endogenous. In this type, the infection has previously occurred in other parts of the body. However, pathogens that cause infection spread to other parts of the body via the bloodstream, including the eyes.

The following are the types of germs that can cause endogenous endophthalmitis:

• Bacteria: N. meningitidis, Staphylococcus aureus, S. epidermidis, S. pneumoniae, bacteria streptococcal, Propionibacterium acnes, Pseudomonas aeruginosa , another gram-negative organism.
• Virus: Herpes simplex virus
• Mushrooms: types of mushrooms Candida
• Parasite: Toxoplasma gondii, Toxocara

3. Phacoanafylactic endoftalmitis

Phacoanafylactic endoftalmitis is a chronic inflammation of the zonal granulomatosa around the ruptured lens. This condition usually occurs after a person goes through eye surgery.

Risk factors

Risk factors are things that can increase a person's chances of developing a condition or disease.

Factors that can increase a person's risk for endophthalmitis are:

• Eye trauma
• Eye surgery
• Intraocular injection into the eye
• Infection of the bloodstream
• Being in a dirty environment and susceptible to germs
• Damage to the eye lens

Treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is this condition diagnosed?

Endoftalmitis is a condition that can cause serious vision problems. An ophthalmologist must diagnose and treat it.

The doctor will review your symptoms and ask about your medical history, especially eye surgery or trauma to the eye.

The doctor will examine your eye. The doctor will test how well you can see in your two eyes.

The doctor will use an ophthalmoscope, which is a device with a light to see the inside of the eye. An ultrasound of the eye may be performed to detect abnormal flakes in the center of the eye.

Your eye doctor may recommend a procedure called a vitreous tap. The doctor will sedate the eye, then use a small needle to draw out a small amount of eye fluid. This fluid is tested for the presence of bacteria or other organisms.

How to treat endophthalmitis?

Treatment for endophthalmitis varies depending on the cause and vision condition of the affected eye.

If endophthalmitis is caused by a bacterial infection, several possible treatment options include:

1. Intravitreal antibiotics

In this medicinal procedure, antibiotics are injected directly into the eye. Usually a part of the vitreous is removed to make room for antibiotics.

2. Corticosteroids

The doctor can inject a corticosteroid into the eye to reduce inflammation and speed recovery.

3. Intravenous antibiotics

Antibiotics are injected into a vein (IV). Generally, antibiotic infusions are given to patients with severe infections.

4.Topical antibiotics (topical)

Antibiotics can be given to the surface of the eye if there is a wound infection that accompanies endophthalmitis.

5. Vitrectomy

The vitreous fluid in the infected part of the eye is removed and replaced with a sterile liquid. This is usually done when the vision loss is so severe that the patient is almost blind.

Quoted from the journal Clinical Microbiology and Infection , vitrectomy can make vision better in people who have severe vision loss. This procedure is also recommended in cases that fail to respond to intravitreal antibiotics.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat endophthalmitis?

Some types of lifestyle and home remedies that can help you deal with endophthalmitis are:

1. Reducing the risk of infection

If you've had cataract surgery, you can reduce your risk of infection. Follow the doctor's instructions for eye care after surgery. In addition, visit the doctor regularly for eye examinations.

2. Wear eye protection

To prevent endophthalmitis caused by eye trauma, wear eye protection at work and during sports. Swimming goggles, eye protection, and helmets can protect against industrial debris that can injure the eyes.