POST-OPERATIVE INFECTIOUS ENDOPHTHALMITIS Flashcards
Define endophthalmitis.
Intraocular inflammation involving the vitreous, anterior chamber, retina and choroid is known as endophthalmitis.
Name the 2 types of endophthalmitis.
Infectious (exogenous and endogenous) and non-infectious
Define post-operative infectious endophthalmitis.
A severe inflammation involving the anterior and posterior segments of the eye after intraocular surgery from an infectious agent.
What are the classifications of post-operative infectious endophthalmitis?
- Acute post op infectious endophthalmitis
- Chronic post op infectious endophthalmitis
Give 4 risk factors of endophthalmitis.
PERIOPERATIVE RISK FACTORS
Pre existing ocular infections (blepharitis, conjunctivitis, nasolacrimal disease)
Comorbidities (diabetes)
Age over 80 years
OPERATIVE RISK FACTORS
Prolonged surgery, intraocular lens, unsterilized instruments, surgeons own hands
List 7 clinical features of endophthalmitis.
Pain
Visual loss
While in the delayed onset the patient presents with painless progressive visual deterioration which may be associated with floaters
Lids become red and swollen
Conjunctiva shows chemosis and marked circumcorneal congestion
Cornea is edematous, cloudy and ring infiltration may be formed
Edges of the wound become yellow and necrotic and wound may gape in exogenous form
Anterior chamber shows hypopyon; soon becomes full of pus
Iris when visible is edematous
Pupil shows yellow reflex due to purulent exudation in vitreous
Vitreous exudation; amaurotic cat’s eye reflex
Low grade anterior uveitis sometimes with mutton fat keratic precipitates
Give 3 differential diagnosis for endophthalmitis.
- Post operative uveitis
- Keratitis
- Vitreous hemorrhage
- Toxic reaction
What are the important investigations in endophthalmitis? (2)
- Smear examination
- Culture
What are the following media for:
a) Chocolate agar
b) Blood agar
c) Sabouraud’s agar
d) Thioglycolate media
e) Anaerobic media
a) Bacteria, fungi
b) Bacteria, fungi
c) Fungi
d) Bacteria, fungi
e) Propionibacterium acnes and other anaerobes
Which imaging modality is used?
B-scan
How is endophthalmitis managed?
MEDICAL
Intravitreal antibiotics
- Vancomycin 1mg in 0.1mL combined with either amikacin 0.4mg in 0.1mL or ceftazidime 2mg in 0.1mL
Corticosteroids
- Intravitreal dexamethasone 0.4 mg in 0.1 ml
- Prednisolone systemically
SURGICAL
- Pars plana vitrectomy
What is the supportive management of endophthalmitis?
Cycloplegics
- 1% atropine or 2% homatropine eye drops - TDS or QID
Antiglaucoma drugs
- In patients with raised intraocular pressure drugs such a oral acetazolamide (250 mg TDS) & timolol (0.5% BD) may be prescribed
