Endophthalmitis
Sympathetic uveitis
Endophthalmitis is an inflammatory reaction caused by an infection in the eye. It also speaks of an intravitreal infection. Endophthalmitis is a very serious disease that often leads to complete loss of vision or even the entire eye by itself. Endophthalmitis is a true rare but dramatically extending eye infection, the prognosis is often very unfavorable ( hopeless ). The infection of the entire eye structure called Panophthalmitis.
Etiology
At the causes (etiology ), a distinction between an exogenous and an endogenous infection. When exogenous endophthalmitis occurs an infection of the cornea ( cornea), for example, after an eye operation as a result of non-sterile surgical conditions. The exogenous form is significantly more common than the endogenous endophthalmitis as a secondary infection from an organ infection by pathogens (bacteria, fungi, viruses or parasites) that spread throughout the body ( sepsis).
Mostly it is a bacterial infection, for example, due to a surgery complication ( non-sterile operating conditions or postoperative), after injuries of the eye ( post- traumatic) and metastatic in immunocompromised patients (diabetes, AIDS ) ( endogenously - metastatic) occurs.
Pathogen
Possible causative agent of endophthalmitis may be:
Bacteria
Staphylococci, streptococci, enterococci, Enterobacteriacae, Pseudomonas aeruginosa, Bacillus spp., Proteus spp., Mycobacteria spp., Treponema pallidum
Mushrooms (Fungi )
Candida spp., Blastomyces dermatitides, Coccidoides immitis, Aspergillus spp., Mucor spp., Fusarium spp., Penicillium spp.
Viruses
Cytomegalovirus (CMV ), herpes simplex virus, varicella- zoster virus, measles virus, rubella virus
Parasites
Taenia solium, Toxocara canis, Toxoplasma gondii
Symptoms
The symptoms of endophthalmitis are a deep dull eye pain, an acute red eye, swelling of the conjunctiva and a visual acuity reduction.
Incidence (frequency )
In the U.S. 1990, 1200 postoperative Endophthalmitisfälle, that is, cases in which the endophthalmitis occurring after an operation registered. This was most common after intraocular surgery, especially after cataract extractions ( cataract surgery). The incidence in the U.S. and Germany is about 0.08%.
However, the disease sometimes occurs even after minor surgery, such as radial keratotomy, posterior capsulotomy, and Vorderkammerparazentese Linsenreposition. The incidence after trabeculectomy and corneal transplantation is approximately four to nine times as high. This is mainly because these interventions, compared to cataract surgery (cataract ), are performed far less often.
In principle, endophthalmitis occur in all procedures on the eye, breaking through the cornea / sclera barrier.
Diagnostics
The detection of pathogens from aqueous humor or the vitreous is especially important given the range of the possible pathogens.
Therapy
Endophthalmitis must be treated with antibiotics. The antibiotic may be administered as eye drops, or as intravenous injections to ( intravitreal ), or around the eye. For bacterial pathogens following antibiotics can thereby be used: ampicillin, oxacillin, cefazolin, together with ceftazidime, penicillin G 600 E, vancomycin and clindamycin. This local therapy must be supplemented by a high-dose systemic therapy. In severe cases of endophthalmitis can also be an intervention on the vitreous ( vitrectomy ) may be necessary.
Forecast
The prognosis depends largely on the virulence of the germ and the duration of the infection. Frequently occurs on a far-reaching loss of function of the eye as a result of damage to the retina. In extreme cases, the eye must be removed ( enucleation ).