Endopthalmitis

ENDOPHTHALMITIS

ENDOPHTHALMITIS Inflammation of the inner coats of

eyeball Especially ant and post. chambers

CLASSIFICATION

Classification

STERILE ENDOPHTHALMITIS Post operative sterile endophthalmitis

Post traumatic endophthalmitis Phacoanaphylactic endophthalmitis Intra ocular tumor necrosis

Intraocular lensinstruments

ACUTE BACTERIAL ENDOPHTHALMITIS Complication of intraocular surgery Infective source-patient’s own flora Symptoms

Severe ocular pain Redness Lacrimation Photophobia Loss of vision

SIGNS•Lid edema

•Chemosis

•Corneal clouding

SIGNS Hypopyon

Fibrin membrane in ant. chamber

SIGNS Wound gaping

Yellow reflex

Retinal periphlebitis (early sign)

InvestigationsVitreous tap

•Topical anesthesia•Trans conjunctively•23-guage needle•0.1ml aspirated

Gram staining Sensitivity test culture

INVESTIGATIONS Fundoscopy

B scan-Ultrasound

Differential diagnosis Occult retention of lens cortex or

nucleus Hypopyon uveitis (Behcet’s or rifabutin) Blebitis Keratitis Toxic anterior segment syndrome (TASS)     

TREATMENTANTIBIOTICSIntravitreal

Topical

Systemic

VANCOMYCIN 1mg in 0.1ml + CEFTAZIDIME 2.25mg in 0.1ml

VANCOMYCIN 1mg in 0.1ml + AMIKACIN 0.4mg in 0.1ml

VANCOMYCIN or CEFAZOLINE

AMIKACIN or TOBRAMYCIN

CIPROFLOXACINVANCOMYCINCEFAZOLINE

TREATMENTSTEROIDSIntravitreal- DEXAMATHASONE(0.4mg in 0.1ml)

Topical – DEXAMETHASONE(0.1%)

Systemic – PREDNISOLONE

TREATMENT Cycloplegics - 1% atropine

Antiglaucoma - Acetazolamide or Timolol

SURGICAL TREATMENT PARS PLANA VITRECTOMY

• Two port

• Three port

PANOPHTHALMITIS Intense pururlent inflammation of whole

eye ball Symptoms

Severe ocular pain n head acheComplete loss of visionProfuse wateringPurulent dischargeMarked redness and swelling

Proptosis and painful movement of eyeball Lid edema chemosis Corneal edema n clouding Anterior chamber full of pus IOP Globe perforation

Signs

COMPLICATIONS Orbital cellulitis Cavernous sinus thrombosis Meningitis

TREATMENT Anti inflammatory n analgesic Broad spectrum antibiotic Evisceration