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    Endophthalmitis

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    Nazmi
    Endophthalmitis is an inflammation of the internal layers of the eye caused by infectious agents. It is divided into three groups: post-surgical, post-traumatic, and endogenous. Post-surgical endophthalmitis is a catastrophic complication of intraocular surgery and can occur early within days or be delayed months to years. Symptoms include pain, vision loss, and hypopyon in the anterior chamber. Treatment involves topical, intraocular, and systemic antibiotics, as well as vitrectomy in severe cases. Prevention focuses on proper aseptic technique during surgery and treating pre-existing ocular infections.

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    Endophthalmitis

    Uploaded by

    Nazmi
    112 views30 pages
    Endophthalmitis is an inflammation of the internal layers of the eye caused by infectious agents. It is divided into three groups: post-surgical, post-traumatic, and endogenous. Post-surgical endophthalmitis is a catastrophic complication of intraocular surgery and can occur early within days or be delayed months to years. Symptoms include pain, vision loss, and hypopyon in the anterior chamber. Treatment involves topical, intraocular, and systemic antibiotics, as well as vitrectomy in severe cases. Prevention focuses on proper aseptic technique during surgery and treating pre-existing ocular infections.

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    Endophthalmitis is an inflammation of the internal layers of the eye caused by infectious agents. It is divided into three groups: post-surgical, post-traumatic, and endogenous. Post-surgical endophthalmitis is a catastrophic complication of intraocular surgery and can occur early within days or be delayed months to years. Symptoms include pain, vision loss, and hypopyon in the anterior chamber. Treatment involves topical, intraocular, and systemic antibiotics, as well as vitrectomy in severe cases. Prevention focuses on proper aseptic technique during surgery and treating pre-existing ocular infections.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    112 views30 pages

    Endophthalmitis

    Uploaded by

    Nazmi
    Endophthalmitis is an inflammation of the internal layers of the eye caused by infectious agents. It is divided into three groups: post-surgical, post-traumatic, and endogenous. Post-surgical endophthalmitis is a catastrophic complication of intraocular surgery and can occur early within days or be delayed months to years. Symptoms include pain, vision loss, and hypopyon in the anterior chamber. Treatment involves topical, intraocular, and systemic antibiotics, as well as vitrectomy in severe cases. Prevention focuses on proper aseptic technique during surgery and treating pre-existing ocular infections.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 30

    ENDOPHTHALMITIS

    ENDOPHTHALMITIS

    Endophthalmitis is an inflammation of
    the internal layers of the eye due to
    infectious agents and manifesting with
    exudation into the vitreous cavity &
    anterior chamber.
    ENDOPHTHALMITIS
    Colonization of organisms
    I. By breach in the ocular coats
    (EXOGENOUS ENDOPHTHALMITIS)
    II. By dissemination through the systemic
    bloodstream. (ENDOGENOUS
    ENDOPHTHALMITIS
    ENDOPHTHALMITIS

    Endophthalmitis is divided into three broad groups

    I. Post surgical endophthalmitis

    II. Post traumatic endophthalmitis

    III. Endogenous endophthalmitis


    POST SURGICAL
    ENDOPHTHALMITIS
     Post-operative endophthalmitis is a catastrophic
    complications of intraocular surgery.
    Causes :
    1. Intraocular surgery- commonest.
    2. Inadvertent perforation during an extra-ocular
    surgery
    3. Squint/retinal detachment surgery
    4. Glaucoma surgery, Penetrating Keatoplasty.
    POST SURGICAL
    ENDOPHTHALMITIS

    1. Early endophthalmitis : Within few days


    to weeks
    2. Delayed endophthalmitis: After two
    months to years
    1. Bacterial endophthalmitis
    2. Fungal endophthalmitis
    Bacterial Endophthalmitis
     Within 4 days of surgery – Causitive Org.
    Gram negative bacteria
    Streptococci & staph.aureus
     Within 5-7 days of surgery – Causitive Org.

    Staph. Epidermidis / Pseudomonas / E.Coli / fungal


     Beyond 7 days – Causitive Org.

    Propioni bacterium Acnes / Fungi / Staph.


    epidermidis
    symptoms & signs
     Pain
     Poor recovery or sudden and rapid diminution of vision
     Corneal edema
     Pupillary membrane
     Hypopyon
     I.O.P - Low or Normal but may be elevated in early stage.
     Iris pattern is lost
     Vitreous Exudation – Snowball exudates
    ON EXAMINATION

     Visual acuity - Hand movements / P.L


     Conjunctiva - Hyperemia, Chemosis &
    Circumcorneal Congestion. A limbal ring
    abscess, suture abscess
     Anterior chamber - Flare, Cells & Hypopyon
    (cardinal sign).
    INVESTIGATION

    Aspirates from the aqueous & Vitreous cavity is


    given for culture & sensitivity
    TREATMENT / BACTERIAL

    1. Atropine / Homatropine – Eye Drops Twice a day


    2. Topical fortified preparation of broad spectrum antibiotics
    * Gentamycin – 80 mg vial of gentamycin mixed
    with commercial gentamycin eye drops -
    15 mg / ml
    * Tobramycin - 80 mg vial of tobramycin mixed
    with commercial tobramycin eye drops -
    15 mg / ml
    * Cefazolin – 500 mg of cefazolin mixed with
    10ml of distilled water - 50 mg/ml
    3. Topical Steroids 0.1 % dexamethosone every
    half hourly
    4. Sub conjunctival injection of gentamycin
    20mg / Beta or dexamethasone 4mg daily for
    5-7 days
    5. Systemic antibiotic – Intravenous ceftazidime
    2gms 8 hourly / IV ciprofloxacin 500mg BD /
    oral 750mg 8 hourly.
    Intravitreal antibiotics – without waiting for
    culture report start the patients on
    1. Gentamycin 0.2 mg in 0.1ml solution

    2. Amikacin 0.4 mg in 0.1 ml solution

    3. Vancomycin 1mg in 0.1 ml solution


    TREATMENT / FUNGAL

    Systemic Antifungal Therapy


    There are three major groups
    1. Polyenes
    Amphotericin 0.7-1mg / kg / day slow I.V
    2. Azoles
    Ketoconazole -400 mg / day
    Fluconazole-200mg / day
    3. Fluocytosine-50-100mg / kg / day
     Antifungal agents that have been used as
    intravitreal drugs.
    Amphotericin B (5-10 ug / 0.1ml)
    Fluconazole (25 ug / 0.1ml)
    ROLE OF VITRECTOMY
     If the infection responds to the medical
    therapy continue the same.
     The infection dose not respond to treatment a
    parsplana vitrectomy should be performed
    followed by intravitreal antibiotic & steroids
    PREVENTION OF
    ENDOPHTHALMITIS
     1 in 1000 develop endophthalmitis inspite of early
    treatment /50% become blind
     Hence prior to surgery treat blepharitis /
    conjunctivitis / dacryocystitis
     Prophylactic antibiotics 1 hour before every 10 mints.
     Preparation of skin povidone iodine 5%
     Post op sub-Tenon’s antibiotics
     Meticulous aseptic surgical technique – applying
    opsite
    PANOPHTHALMITIS
    Definition
    Purulent inflammation of the whole eyeball including the
    Tenons capsule
    Causes : As a complication of Corneal Ulcer /
    Penetrating Injury
    Clinical Features:
    Symptoms: •severe ocularpain and headache
    •complete loss of vision
    •profuse watering
    • purulent discharge
    •redness and swelling of the eyes
    Signs:
    • Vision is completely lost and perception of light is
    absent
    • Eyeball-proptosed,painful restricted ocular
    movements
    • Lids edema
    • Conjunctival chemosis & congestion
    •Cornea is
    cloudy & oedematous
    •AC is full of pus
    Complications
    • Orbital cellulitis
    • Cavernous sinus thrombosis
    • Meningitis or Encephalitis
    Treatment
    - Antibiotics & analgesics
    - Evisceration

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