Endophthalmitis
Updates to Article Attributes
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