Endophthalmitis

What Is It?

Endophthalmitis is an inflammation of the inside of the eye. Inflammation affects the vitreous fluid in center of the eye. Vitreous fluid is a clear, gel-like substance. The inflammation can extend to surrounding tissues responsible for vision. Endophthalmitis is rare. 

In most cases, an infection triggers this inflammation. The infection can be caused by: 

• Bacteria 
• Fungi 
• Viruses  
• Parasites 

In the United States, most cases result from bacterial infections that follow eye surgery. For example, the condition may follow a procedure to treat cataracts or glaucoma. Bacteria also can enter the eye through an injury that pierces the eye. 

Less often, an infection from elsewhere in the body can travel to the eye through the blood.

Symptoms

The most common symptoms are loss of vision and pain. Additional symptoms vary. They depend on what caused the eye infection:  

• Postoperative endophthalmitis. The most common cause of this condition is a bacterial infection after cataract surgery. This serious problem can lead to permanent loss of vision.  Symptoms vary slightly. They depend on whether the infection occurs early (six weeks or less) or late (months or years) after surgery.  
  • Early symptoms can include: 
    • A dramatic decrease in vision in the affected eye 
    • Eye pain that worsens after surgery 
    • Red eyes  
    • Swollen eyelids  
  • Late symptoms tend to be milder than early symptoms. They may include: 
    • Blurred vision 
    • Increased sensitivity to bright light   
    • Mild eye pain 
• Posttraumatic endophthalmitis. Symptoms caused by a penetrating eye injury are generally dramatic: 
  • A dramatic decrease in vision in the affected eye 
  • Eye pain that becomes worse 
  • Red eyes  
  • Swollen eyelids 
• Hematogenous endophthalmitis. This is when an infection spreads through the bloodstream and settles in the eye. Symptoms may develop gradually and be fairly subtle. For example: 
  • A mild decrease in vision over a period of a few weeks 
  • The appearance of floaters. These are dark, semi-transparent, floating shapes in the field of vision. 

Diagnosis

Endophthalmitis can lead to serious vision problems. A medical doctor who specializes in eye problems (an ophthalmologist) must diagnose and treat it.  

The doctor will review your symptoms. He or she will ask about your medical history, especially any eye surgery or eye trauma. 

The doctor will examine your eyes. He or she will test how well you see in both eyes. The doctor will use an ophthalmoscope. This is a lighted instrument for looking inside the eye. An ultrasound of the eye may be ordered. Ultrasound can detect abnormal debris in the center of the eye. 

The ophthalmologist may recommend a procedure called a vitreous tap. The doctor anesthetizes the eye. He or she then uses a tiny needle to withdraw some of the eye's internal fluid. This fluid is tested for bacteria or other organisms.

Expected Duration

For the best chance to preserve and restore your vision, the condition must be treated promptly. Once treatment begins, symptoms may begin to improve within a day or two. In many cases, eye pain and eyelid swelling lessen before vision gets better.

Prevention

If you have had cataract surgery, you can help to decrease your risk of infection. To do so, follow your doctor's instructions for eye care after your surgery. Also, see your doctor regularly for follow-up eye exams.  

To prevent endophthalmitis caused by eye trauma, use protective eyewear at work and during contact sports. Goggles, eye shields and helmets can help protect against industrial debris that can pierce or cut the eyes.

Treatment

Treatment depends on: 

• What caused the endophthalmitis  
• The state of vision in the affected eye  

When the condition is caused by a bacterial infection, options include one or more of the following:  

• Intravitreal antibiotics. Antibiotics are injected directly into the infected eye. Usually, some vitreous is removed to make room for the antibiotic.  
• Intravenous antibiotics. Antibiotics may be injected into a vein. This may be prescribed for patients with severe infection.  
• Topical antibiotics. Antibiotics may be applied to the surface of the eye when there is a wound infection in addition to endophthalmitis.  
• Vitrectomy. Part of the eye's infected vitreous fluid is removed. It is replaced with sterile saline or another compatible liquid. This usually is done if vision loss is so severe that the person is nearly blind. 

When the condition is caused by a fungal infection, doctors usually inject an antifungal medication directly into the infected eye. The medication may also be given intravenously. Or, the person may receive an oral antifungal drug. 

The ophthalmologist will monitor your progress. You will have frequent eye exams to monitor whether the treatment is improving your vision or not. 

When To Call a Professional

Endophthalmitis is a medical emergency. It can cause permanent loss of vision if not diagnosed and treated promptly.  

Call your doctor immediately if you develop symptoms of this condition. This is particularly important if you have a history of: 

• Eye surgery 
• Eye trauma  
• Any condition that weakens your immune defenses

Prognosis

With proper treatment, many people have a good prognosis.

Additional Info

National Eye Institute
https://www.nei.nih.gov/

American Academy of Ophthalmology
https://www.aao.org/