الفهرس 
Sterile EndophthalmitisOnly 14 pages are availabe for public view
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Abstract
Endophthalmitis is a term used for a severe inflammation of the intraocular structure always involving the ocular fluids (the vitreous, the aqueous or both). The cause may be infectious or non-infectious. Non-infectious endophthalmitis is also called sterile endophthalmitis or panuveitis. It may be caused by agents such as retained lens matter, residual chemicals from sterilization and mechanical irritation of the iris and ciliary body by the lens.
Infectious endophthalmitis is an inflammatory reaction of intraocular tissues and fluids caused by microbial agents which is frequently associated with congestion of the periocular structures and conjunctiva, pain, hypoyon, vitreal abscess and visual loss.
It can divided into five main categories: (1)Acute postoperative endophthalmitis (2)Delayed-onset postoperative endophthalmitis (3)Post-traumatic endophthalmitis (4) Endogenous endophthalmitis (5) Endophthalmitis following an intractable infection of the external coats of the globe.
The majority of exogenous infections are due to aerobic bacteria, although anaerobic bacteria and fungi are also implicated.A sudden decrease in vision, redness, increasing eye aches, eyelid edema and chemosis are the predominant symptoms in majority of cases. Intense flare and fibrin may be detected in the anterior chamber, with or without hypoyon. The pupil may show irregularities with posterior synechia. The vitreous is hazy preventing visualization of the fundus. Other signs include massive conjuctival congestion with purulent discharge, corneal edema and hyperemia. The diagnosis is done by obtaining intraocular (aqueous and vitreous) specimens.
The best strategy against infection includes the treatment before surgery of any pre-existing external infection, careful preoperative preparation, a meticulous surgical techniques and the administration of pre- and postoperative antibiotics.
The management options in postoperative endophthalmitis include antimicrobial therapy (Intravitreal, topical and systemic therapy); anti-inflammatory therapy (Intravitreal, topical and systemic corticosteroids and NSAIDs); supportive therapy (Cycloplegics, anti-glaucoma medication etc.) and surgery (Vitrectomy).
Delayed-onset postoperative endophthalmitis is diagnosed when signs of endophthalmitis are observed 4 weeks or more after surgery. In the majority, after an uneventful early postoperative period, a low-grade inflammation (chronic iridocyclitis) not responding fully to local antibiotics and/or corticosteroids is observed.
Delayed-onset postoperative endophthalmitis should be handled in the same manner as acute postoperative cases. Steroids should not be used during the initial phases.
Endophthalmitis following intraocular trauma is different from other forms of endophthalmitis because of several reasons. First, disorganization of normal anatomy due to the trauma. Second, the organisms producing the infection are more virulent and have a higher degree of pathogenicity. Third, the protocol for management remains ill-defined.
Collection of intraocular samples for laboratory investigations is necessary as in cases of post-operative endophthalmitis. However, it is more difficult to collect the sample because of the distorted anatomy and associated clinical features (e.g. extreme hypotony).
Intravitreal antibiotics alone have a limited efficacy in post-traumatic endophthalmitis and so many such cases need early vitrectomy followed by intravitreal injection of antibiotics.
Individuals at risk for developing endogenous endophthalmitis usually have co-morbidity that predispose them to infection. The source of organism is usually from a foci elsewhere in the body.
Endophthalmitis associated with infection of the globe external coats is a rare cause of endophthalmitis and is mostly associated with chronic indolent infection of the cornea (e.g. corneal abscess).
The management should include a biopsy of the cornea along with a tap from the anterior chamber. If necessary, when the vitreous is involved, a vitreous tap or biopsy should also be performed.
Prompt specific treatment with fortified antibiotic preparations combined with periocular injections may be the most effective measure.