Endophthalmitis

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.

Symptoms

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).

Diagnosis

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.