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Endophthalmitis

Overview

Endophthalmitis is swelling of the internal coats of the eye caused by infection due to complication of all intraocular surgeries, particularly cataract surgery, with possible loss of vision and the eye itself. This disease is caused by bacterial and fungal infection which are introduced at the time of injury. It causes loss of vision, eyelid swelling, photophobia, headache and severe pain.


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Causes

The disease may be caused due to the retention of native lens material after an operation or from toxic agents. Various bacteria that are introduced at the time of injury and cause chronic inflammation can also be the cause. Aspergillosis is the second most common cause of fungal endophthalmitis, especially in IV drug users. Other causes include surgery and intravenous drug abuse. Diseases like meningitis, urinary tract infection, and wound infection also have been implicated as sources of infection. In patients with immunocompromised states like AIDS and  diabetes the spread of infection may be via the blood-stream.


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Signs & Symptoms

The condition is usually accompanied by the redness of the conjunctiva. Signs of inflammation of the various coats of the eye, eye pain and irritation, headache, Photophobia, Intense ocular and periocular inflammation can also be seen. The physical symptoms include Eyelid swelling, Injected conjunctiva, reduced or absent red reflex, Corneal edema and infection, white lesions in the choroid and retina, purulent discharge.

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Prevention

Preventive measures can be undertaken by hospital personnel as this disease is caused by factors incidental to medical treatment. Don't use any O.R. solutions overnight. Start with fresh solutions (cleaning, sterilizing, irrigating) every day. Inspect the irrigating bottle and do not use it if any fungus growth is there on its inside walls. Isolate the lashes and don't touch implant to the lashes.  As much as possible avoid touching implant to cornea and / or conjunctivae. Have patient wash their entire face themselves with soap and water while waiting for surgery. Don't operate on both eyes the same day.


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Treatments
Surgical Modern Medicine

Treatment depends on the underlying cause of endophthalmitis. Urgent examination by an ophthalmologist is must as he/she is the  who will decide for urgent intervention to provide intravitreal and subconjunctival injection of  antibiotics and also prepare for an urgent pars plana vitrectomy. Surgery may be required to remove a blind and painful eye. Antibiotic as well as intravitreal steroids are also helpful. Tetanus immunization is necessary if immunization record is not current. Drops like atropine may be used.

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