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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