Endophthalmitis

Changed by Daniel J Bell, 20 Aug 2017

Updates to Article Attributes

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Endophthalmitis is a potentially sight threatening-threatening condition that involves intra-ocularintraocular inflammation of any cause. Although this can  beIt is either infectious or non-infectious in aetiology, but in clinical practice intraocular infection reflectsinfections are the most common causecommonest

Clinical presentation

Eye pain and discomfort are common presenting symptoms sometimes accompanied by blurred vision. Physical examination can reveal swollen eyelids, chemosis, conjunctival injection, corneal oedema, reduced red reflex, reduced visual acuity  andand raised intraocular pressure. Diagnosis is frequently made clinically, in most cases, based on these features.

Pathology

Bacterial endophthalmitis has been classified as exogenous or endogenous depending on the cause. Exogenous causes frequently include ocular surgery, penetrating injury or spread of periocular infection (i.e. orbital cellulitis).

Endogenous cases comprise only 2-7% of endophthalmitis cases and involve haematogenous seeding of intraocular infection from a primary source. 1

Radiographic features

CT

Often shows non-specific features including:

  • proptosis (due to raised intra-orbitalintraorbital pressure)
  • orbital fat stranding
  • thickening of the sclera
  • choroidal enhancement post-contrast
    • often in early disease
  • hyperdensity of the vitreous humorhumour 
MRI
  • areas of high FLAIR signal in the vitreous humorhumour
  • T1 isointensity or hyperintensity of the vitreous depending on the proteinaceous content
  • restricted diffusion on DWI
    • similar to an abscess, this is virtually diagnostic of endophthalmitis
    • a reducing diffusion restriction is thought to correlate with treatment response 2
  • oedema within the extra-ocularextraocular tissues

Treatment and prognosis

Intravitreal antibiotics are the mainstay of treatment and vitreal aspiration can be performed to identify the causative pathogen. Severe cases may require surgery with vitrectomy and debridement.

  • -<p><strong>Endophthalmitis </strong>is a potentially sight threatening condition that involves intra-ocular inflammation of any cause. Although this can  be infectious or non-infectious, in clinical practice intraocular infection reflects the most common cause. </p><h4>Clinical presentation</h4><p>Eye pain and discomfort are common presenting symptoms sometimes accompanied by blurred vision. Physical examination can reveal swollen eyelids, chemosis, conjunctival injection, corneal oedema, reduced red reflex, reduced visual acuity  and raised intraocular pressure. Diagnosis is frequently made clinically in most cases based on these features.</p><h4>Pathology</h4><p>Bacterial endophthalmitis has been classified as exogenous or endogenous depending on the cause. Exogenous causes frequently include ocular surgery, penetrating injury or spread of periocular infection (i.e. orbital cellulitis).</p><p>Endogenous cases comprise only 2-7% of endophthalmitis cases and involve haematogenous seeding of intraocular infection from a primary source. <sup>1</sup></p><h4>Radiographic features</h4><h5>CT</h5><p>Often shows non-specific features including:</p><ul>
  • -<li>proptosis (due to raised intra-orbital pressure)</li>
  • +<p><strong>Endophthalmitis </strong>is a potentially sight-threatening condition that involves intraocular inflammation of any cause. It is either infectious or non-infectious in aetiology, but in clinical practice intraocular infections are the commonest. </p><h4>Clinical presentation</h4><p>Eye pain and discomfort are common presenting symptoms sometimes accompanied by blurred vision. Physical examination can reveal swollen eyelids, chemosis, conjunctival injection, corneal oedema, reduced red reflex, reduced visual acuity and raised intraocular pressure. Diagnosis is frequently made clinically, in most cases, based on these features.</p><h4>Pathology</h4><p>Bacterial endophthalmitis has been classified as exogenous or endogenous depending on the cause. Exogenous causes frequently include ocular surgery, penetrating injury or spread of periocular infection (i.e. orbital cellulitis).</p><p>Endogenous cases comprise only 2-7% of endophthalmitis cases and involve haematogenous seeding of intraocular infection from a primary source. <sup>1</sup></p><h4>Radiographic features</h4><h5>CT</h5><p>Often shows non-specific features including:</p><ul>
  • +<li>proptosis (due to raised intraorbital pressure)</li>
  • -<li>hyperdensity of the vitreous humor </li>
  • +<li>hyperdensity of the vitreous humour </li>
  • -<li>areas of high FLAIR signal in the vitreous humor</li>
  • +<li>areas of high FLAIR signal in the vitreous humour</li>
  • -<li>similar to an abscess, is virtually diagnostic of endophthalmitis</li>
  • -<li>reducing diffusion restriction is thought to correlate with treatment response <sup>2</sup>
  • +<li>similar to an abscess, this is virtually diagnostic of endophthalmitis</li>
  • +<li>a reducing diffusion restriction is thought to correlate with treatment response <sup>2</sup>
  • -<li>oedema within the extra-ocular tissues</li>
  • +<li>oedema within the extraocular tissues</li>

Tags changed:

  • ophthalmology

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