Endophthalmitis – A serious eye infection
Endophthalmitis is a serious infection of the inside of the eye. It can occur following surgery, an intravitreal injection, or septicemia (endogenous form). It manifests as a sudden red and painful eye, with a decrease in deep vision. Treatment involves intravitreal injections of antibiotics and periocular anti-inflammatory medications. The prognosis remains guarded, and visual impairment is common.
What is endophthalmitis?
Endophthalmitis is an infection of the tissues or fluids inside the eyeball.
This is a serious ophthalmological emergency occurring as a result of ophthalmic surgery, eye trauma, or septicemia.
Endophthalmitis leads to the systematic loss of the eye if it is not treated early.
Types of endophthalmitis
There are two main types of endophthalmitis:
Exogenous endophthalmitis – This is the most common form of endophthalmitis. In this case, the source of the infection comes from outside the body. A bacterium or fungus enters the eye following surgery, an injection into the eyeball, or an injury with a perforation of the eye.
Symptoms usually appear 5 to 7 days after the procedure or injury. When symptoms appear this quickly, it is considered acute endophthalmitis.
The infection can also develop more slowly. When symptoms take longer to appear, it is called chronic endophthalmitis. This occurs when slow-replicating bacteria or fungi enter the eye.
Endogenous endophthalmitis – This is a rarer type of endophthalmitis. It begins with an infection in another part of the body and spreads to the eye. For example, this can occur during a heart infection (endocarditis) or a blood infection.
Causes and risk factors
Eye injections and cataract surgery are the two most frequent eye procedures and therefore the most likely to cause endophthalmitis, although it is rare (1/10,000 patients).
If you experience any unusual symptoms a few days after a procedure, consult your ophthalmologist immediately. The infection can worsen very quickly.
Symptoms
The most common symptoms of endophthalmitis are as follows:
Eye pain – that continues to worsen after eye surgery, an injection, or an injury
Vision loss – Sudden, a few days after the procedure.
Diffuse eye redness
Pus or white or yellow eye discharge
Diagnosis
Your ophthalmologist will perform several tests to diagnose endophthalmitis. They will examine your eye and test your vision.
The eye will be inflamed and vision will be poor.
The doctor will identify Tyndall's phenomenon (inflammatory cells), cyclic membrane (veils of infection) and hyalitis (inflammation of the vitreous humor).
If you have suffered an eye injury, your doctor may order a scan to look for an intraocular foreign body.
Diagnostic confirmation – Aqueous humor sampling
If your doctor thinks you have an infection, he or she will refer you to a specialist center or perform a test himself called anterior chamber tap or aqueous humor sampling.
This test involves using a small needle to collect a small amount of fluid from your eyeball.
The liquid is then sent to a laboratory to identify the bacteria.
Treatment
Treatment most often involves hospitalization for 3 to 5 days.
It consists of an emergency intravitreal injection of 2 antibiotics or an antifungal drug.
A corticosteroid may also be injected to reduce swelling and inflammation caused by the infection.
If recovery is slow, you may also undergo a vitrectomy. Your ophthalmologist removes the infected vitreous gel from your eye. They then inject silicone to allow the retina to rest in a bactericidal environment.
Complication
Without treatment, endophthalmitis invariably leads to the loss of the eye. However, despite early intervention and proper treatment, visual impairment remains common.
The main complications are:
Profound and irreversible vision loss.
Retinal detachment.
Chronic eye pain.
Phthysis – Loss of ocular tone.
Prevention
Prevention of endophthalmitis relies on sterility procedures in the operating room and during the instillation of postoperative treatments.
During the procedure – Your surgeon will thoroughly disinfect your eye and eyelids before beginning the operation. They will then cover your eye with a sterile drape and use sterile instruments. At the end of the procedure, they will administer antibiotics to reduce the risk of a hospital-acquired infection tenfold.
After the operation – Follow your doctor's instructions for home care after eye surgery or an eye injection. For example, wash your hands before putting in eye drops. Do not let the eye drop bottle touch the eye, as this could contaminate the dropper.
Cases of endophthalmitis following ocular trauma
Use protective eyewear when performing household tasks that could injure the eye.
This includes activities such as sawing wood or welding metal.
Wear appropriate eyewear and safety equipment during contact sports.
If you see any projections, seek medical help immediately.
Consult an SOS Eye urgently – 7 days a week
A free appointment?
Block it on Doctolib:
No more room?
Simply come in during opening hours without an appointment:
Open 7 days a week
8:00–21:00 Monday to Friday
9:00–19:00 weekends and public holidays
Any questions?
Contact us on WhatsApp: