Definition: Endophthalmitis is an intraocular infection, an infection inside the eye. There are multiple different types of endophthalmitis, but the most common type is post-operative endophthalmitis. This condition occurs most commonly after cataract surgery, typically afflicting approximately one in every 1,000 patients. In most cases, surgery was routine and uncomplicated, though certain surgical complications may increase the incidence of this infection. Patients typically present with a rather sudden onset of progressively worsening vision, pain, and red eye. Most patients present with the condition 3 to 12 days after surgery.
The causative agent in post-operative endophthalmitis is invariably bacterial and is almost always an organism that can be found as part of the normal flora of the eyelids. The most common bacterial species is a type of “staph” infection known as Staphylococcus epidermidis. Other “staph” and “strep” (streptococcal) species are only slightly less common.
Your ophthalmologist makes the diagnosis based on an examination. In general, cultures are obtained from both the anterior chamber and vitreous humor of the eye. Antibiotics and, in some cases steroids, are injected into the eye and the patient is started on frequent topical antibiotic eye-drops. Hospitalization is often required, due to the need for around-the-clock antibiotic eye-drops. Patients with very poor presenting visual acuity are usually scheduled for a vitrectomy as this improves the prognosis for that group of patients.
Treatment: Treatment depends on the cause of endophthalmitis and the state of vision in the affected eye. For endophthalmitis caused by a bacterial infection, options include one or more of the following:
- Vitrectomy — Part of the eye’s infected vitreous fluid is removed and replaced with sterile saline (a salt solution) or some other compatible liquid. This usually is performed if the loss of vision is severe.
- Intravitreal antibiotics — Antibiotics are injected directly into the infected eye. The choice of antibiotics depends on the type of bacteria causing the infection, as identified in the sample of the eye fluid from the vitreous tap.
- Corticosteroids — In addition to antibiotics, your doctor may also inject corticosteroids into your eye, to decrease inflammation and speed healing.
Topical antibiotics- Antibiotics are applied to the surface of the eye when there is a wound infection in addition to endophthalmitis.
To treat endophthalmitis caused by a fungal infection, doctors usually inject an antifungal medication directly into the infected eye. The medication may be given intravenously or the patient may receive an oral antifungal drug. The ophthalmologist will monitor your progress.
If you have cataract surgery, you can decrease your risk of infection by following your doctor’s instructions for eye care after your surgery and by having regular follow-up eye exams.
To prevent endophthalmitis caused by 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.