What Is It?
Endophthalmitis is an inflammation of the internal structure of the eye, including the central cavity of the eye (filled with clear, gel-like vitreous fluid) and surrounding tissues that are responsible for vision. In most cases, an infection triggers this inflammation. The infection may be caused by bacteria, fungi (microscopic organisms related to molds and mushrooms), viruses or parasites.
Currently in the United States, most cases of endophthalmitis are caused by bacterial infections that follow eye surgery, primarily procedures to treat cataracts or glaucoma. The condition is uncommon, occurring in about one out of every 200 patients. Bacteria also can enter the eye through an injury that pierces the eye.
Less often, an infection from somewhere else in the body can be carried to the eye through the blood. This is called hematogenous endophthalmitis.
The most common symptom of endophthalmitis is loss of vision. Additional symptoms vary, depending on what caused the eye infection:
- Postoperative endophthalmitis — The most common cause of endophthalmitis is a bacterial infection after cataract surgery. This complication develops in fewer than one out of every 200 patients who have had cataracts removed. It is a serious problem that can lead to permanent loss of vision. Symptoms vary slightly, depending 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 becomes worse after surgery, red eyes and swollen eyelids.
- Late symptoms tend to be milder than early symptoms and may include blurred vision, increased sensitivity to bright light (photophobia) and mild eye pain.
- Posttraumatic endophthalmitis — Symptoms of endophthalmitis caused by a penetrating eye injury are generally dramatic and similar to the symptoms of early postoperative endophthalmitis — a dramatic decrease in vision in the affected eye, eye pain that becomes worse, red eyes and swollen eyelids.
- Hematogenous endophthalmitis — When an infection spreads through the bloodstream and settles in the eye, symptoms may evolve gradually and be fairly subtle. For example, the person may notice a mild decrease in vision over a period of a few weeks, along with the appearance of floaters (dark, semi-transparent, floating shapes in the field of vision).
Because endophthalmitis can lead to serious vision problems, an ophthalmologist (a medical doctor who specializes in eye problems) must diagnose and treat it. After reviewing your symptoms, the doctor will ask questions about your medical history, especially any history of eye surgery or eye trauma.
Next, the doctor performs a thorough eye exam, testing how well you see in both eyes. The doctor also uses an ophthalmoscope, a lighted instrument for looking inside the eye. An ultrasound, the same kind that produces images of a fetus in the womb, is used to look at the internal structures of the eye.
The ophthalmologist may recommend a procedure called a vitreous tap. To perform this procedure, the ophthalmologist anesthetizes the eye and uses a tiny needle to withdraw some of the eye’s internal fluid. This fluid is then tested for the presence of bacteria or other organisms.
For the best chance to preserve and restore your vision, endophthalmitis must be treated promptly. Once treatment begins, symptoms can begin to improve within 24 to 48 hours. In many cases, eye pain and eyelid swelling lessen before vision gets better.
If you have had cataract surgery, you can help to decrease your risk for infection by following your doctor’s instructions for eye care after your surgery and by seeing your doctor regularly for follow-up eye exam.
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 depends on what causes the 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 so severe that the person cannot see the doctor’s hand motions.
- 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 eye fluid from a vitreous tap.
- Corticosteroids — In addition to antibiotics, your doctor may also inject corticosteroids into your eye, to decrease inflammation and speed healing.
- Intravenous antibiotics — Antibiotics, given by vein, may be prescribed for patients with severe endophthalmitis.
- 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 (such as amphotericin B) directly into the infected eye. The medication may be given intravenously or the patient may receive an oral antifungal drug, such as fluconazole.
The ophthalmologist will monitor your progress. You will have frequent eye exams need to keep the doctor informed about whether the treatment is improving your vision or not. About 10 percent of cases require repeat treatment.
When To Call A Professional
Endophthalmitis is a medical emergency than can cause permanent loss of vision if not diagnosed and treated promptly. Call your doctor immediately if you develop symptoms of endophthalmitis, especially if you have a history of eye surgery, eye trauma or any condition that weakens your immune defenses.
With proper treatment, many patients have a good prognosis. According to one large study by the National Eye Institute, more than 50 percent of patients treated for endophthalmitis after cataract surgery ultimately achieved 20/40 vision (the ability to see at 40 feet what a person with perfect vision can see at 20 feet).
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.