#31. Sympathetic ophthalmia. Endophthalmitis.

Question 1

What is SYMPATHETIC OPHTHALMIA?

Answer 1

• A Specific BILATERAL (Both eyes) INFLAMMATION of the UVEAL TRACT
• DUE to CHRONIC IRRITATION of 1 eye from a PERFORATING WOUND
• PRODUCING Transferred UVEITIS to the OTHER eye

Question 2

What are the CAUSES of SYMPATHETIC OPHTHALMIA?

Answer 2

• PENETRATING Injuries
• INTRAOCULAR Surgery

Question 3

What are the SYMPTOMS of SYMPATHETIC OPHTHALMIA?

Answer 3

• LIMITED Accommodation
• Photophobia (EXTREME sensitivity to light)
• DIMINISHED Visual Acuity
• SEVERE eye pain + REDNESS in BOTH eyes
• FLOATERS in Visual Field
• Watery Eyes
• Visual IMPAIRMENT, leading to BLINDNESS

Question 4

What is the DIAGNOSIS for SYMPATHETIC OPHTHALMIA?

Answer 4

Under a SLIT-LAMP Examination

• See CLUMPS of Inflammatory Cells on POSTERIOR Corneal Surface = MUTTON FAT KERATIC Precipitates
• Swelling
• Thickening of UVEA
• WHITISH Lesions within CHOROID (Layer btw Retina / Sclera)

Question 5

What is the TREATMENT for SYMPATHETIC OPHTHALMIA?

Answer 5

ENUCLEATE the eye = TO ELIMINATE the antigen

HIGH Dose TOPICAL & SYSTEMIC Steroid Therapy

Immunosuppressives
- CYCLOPHOSPHAMIDE
- AZATHIOPRINE

Question 6

What is ENDOPHTHALMITIS?

Answer 6

• Is a INFLAMMATION of INTRAOCULAR CAVITIES

a. Aqueous Humour
b. Vitreous Humour

• DUE to an INFECTION

Question 7

What are the 2 TYPES of ENDOPHTHALMITIS?

Answer 7

1) ENDOGENOUS
- Due to HEMATOGENOUS Spread of Organisms from DISTANT SOURCE (Endocarditis)

2) EXOGENOUS
- Due to DIRECT INOCULATION of Organism
- COMPLICATION from Ocular Surgery
- Foreign Bodies
- Blunt / Penetrating Ocular Trauma

Question 8

What are the CLINICAL FEATURES of ENDOPHTHALMITIS?

Answer 8

• SUDDEN Onset
• SEVERE Pain
• Redness
• Eyelid OEDEMA
• CHEMOSIS
• Corneal HAZE
• FIBRINOUS Exudate in ANTERIOR CHAMBER

Question 9

What is the TREATMENT for ENDOPHTHALMITIS?

Answer 9

BROAD Spectrum Antibiotics for GRAM + / - Organisms

• INTRAVITREAL
  0 Aminoglycoside
  0 Vancomycin
• PERIOCULAR / SUBCONJUNCTIVAL INJECTIONS
  0 Vancomycin + Ceftazidine
  0 Gentamicin + Cefuroxime
• TOPICAL THERAPY = Every 30 - 60 minutes
• SYSTEMIC THERAPY
  0 IV Ceftazidine
  0 IV Ceftotaxime
  0 Oral Ciprofloxacin

Question 10

What is the DIFFERENTIAL DIAGNOSIS of ENDOPHTHALMITIS?

Answer 10

• RETAINED Cortical Lens, associated with Severe ANTERIOR UVEITIS
• TOXIC Reaction to Irrigating fluid, chemicals or foreign material
• PANOPHTHALMITIS