How does infection get inside the eye?
Most often, the pathogen penetrates from the outside through the damaged membrane of the eye. This may be a surgical incision after cataract removal, a puncture during an intraocular injection, a wound due to trauma, or a corneal ulcer. This variant is called exogenous, and it accounts for the vast majority of cases. Less commonly, microorganisms are brought by blood from a distant focus - in sepsis, inflammation of the inner lining of the heart, abscesses, in people with intravenous catheters; this option is called endogenous, it is often bilateral and requires searching for the source of infection throughout the body.
- After eye surgery, most often cataract
- After intraocular injection
- For penetrating wounds and foreign bodies
- For severe corneal ulcers
- Endogenous route - transfer with blood
- Fungal forms develop more slowly
Symptoms
The classic picture of acute endophthalmitis appears in the first days after surgery or injury. The eye turns red, deep pain increases, the eyelids swell, vision quickly deteriorates - down to the ability to only distinguish light. Patients report fog, floaters, and photophobia. Upon examination, the doctor sees clouding of the intraocular media and often a level of pus in the anterior chamber. It is important to remember: slight discomfort and redness in the first days after surgery are normal, but increased pain along with decreased vision is always a reason for immediate treatment.
- Rapid loss of vision
- Increasing pain in the eye
- Redness of the eye and swelling of the eyelids
- Photophobia and lacrimation
- Floaters, fog before the eye
- Pus in the anterior chamber of the eye
Diagnostics
The diagnosis is made by an ophthalmologist based on the clinical picture during examination at a slit lamp, always with checking visual acuity and measuring intraocular pressure. If cloudiness of the media does not allow the fundus to be seen, an ultrasound examination of the eye is performed, which shows inflammatory changes in the vitreous and excludes retinal detachment. To select an accurate treatment, a sample of the intraocular fluid is taken for culture and sensitivity to antibiotics - the collection is performed simultaneously with the administration of the drug. With the endogenous variant, they additionally look for the source of infection in the body.
- Slit lamp examination
- Checking visual acuity and intraocular pressure
- Ultrasound of the eye in B-scan mode
- Collection of intraocular fluid for culture
- Determination of sensitivity to antibiotics
- Search for the source of infection in the endogenous form
Treatment
The basis of treatment is the introduction of antibiotics directly into the eye cavity: this is the only way to create the required concentration of the drug where the infection develops. In severe cases and very low vision, vitrectomy is performed - removal of the affected vitreous body with simultaneous administration of drugs. Additionally, drops and sometimes systemic medications are prescribed. Anti-inflammatory therapy is included according to the doctor’s decision. If it is fungal in nature, antifungal agents are used and treatment lasts longer. Self-medication with drops at home is unacceptable: it only wastes time.
- Injecting antibiotics into the eye
- Vitrectomy for severe cases
- Local drop therapy
- Systemic antibiotics for the endogenous form
- Antifungal drugs for fungal infections
- Treatment in an ophthalmological hospital
Prevention and prognosis
The risk of endophthalmitis after elective eye surgery is very low due to eye antiseptic treatment, sterile conditions and prophylactic antibiotic administration. A lot depends on the patient: strictly follow the instillation regimen, do not rub the eyes, do not swim in open reservoirs and pools in the early period, and come for examinations. If you have an eye injury, you should not try to remove the foreign body yourself - you need to cover the eye with a clean bandage and immediately consult a doctor. The prognosis depends on the pathogen and the time of treatment: part of the vision can be preserved in a significant proportion of patients if help is provided quickly.
- Compliance with prescriptions after eye surgery
- Do not rub your eye and protect it from water
- Timely follow-up inspections
- Immediate treatment for pain and loss of vision
- In case of injury, cover your eye with a bandage and go to the doctor.
- Treatment of chronic foci of infection and control of diabetes mellitus
