Infectious etiology is the most common and various bacteria and fungi have been isolated as the cause of the endophthalmitis. Other causes include penetrating trauma and retained intraocular foreign bodies.

Endophthalmitis can be exogenous or endogenous. The most common type of exogenous endophthalmitis is post-operative, such as after a cataract surgery. Other exogenous causes include ruptured globe or intraocular foreign body.

Endogenous endophthalmitis results from bacteria that originated from another part of the body, which spread to the eye from the source of infection through the blood stream. Non-infectious, or sterile, endophthalmitis can result from inflammation related to retained lens material or a reaction to intraocular drugs such as steroids.

Non-infectious endophthalmitis is also characterized by severe inflammation in the eye.

Patients having failed intraocular surgeries are more prone to endophthalmitis. Sometimes this occurs when lens material is found outside of its protective capsule. This can occur when a mature cataract liquefies and leaks lens material or if some lens is left behind after cataract surgery. In addition, inflammation can occur in response to certain pharmacologic agents or to the preservatives added to their formulation.

Ans4- In cases of endophthalmitis, one usually finds a history of recent intraocular surgery or penetrating ocular trauma. In some cases of metastatic endophthalmitis— particularly in immunocompromised patients or those with diabetes—the spread of infection may have been hematogenous (via the blood-stream).

Endophthalmitis is usually accompanied by severe pain, loss of vision, and redness of the conjunctiva and the underlying episclera. Also present are signs of inflammation of the various coats of the eye. Hypopyon can be present in endophthalmitis and should be looked for on examination by a slit lamp.

An eye exam may be indicated in severe forms of candidiasis. 1-3% of cases of candidal blood infections include endophthalmitis.

The diagnosis of endophthalmitis is made by clinical examination. When a doctor examines the patient, he or she will use a slit lamp which projects a bright light on and into the eye. Typical features of endophthalmitis include a red eye, corneal edema, and a dense collection of white blood cells that settle at the bottom of the front of the eye called a hypopyon. If it is possible to see through the dense inflammation in the anterior part of the eye, the doctor may also see white blood cells behind the lens in the posterior part of the eye.Sometimes, the ophthalmologist cannot visualize the back of the eye because the inflammation is so severe in the front of the eye. In these cases, an ultrasound (or B- scan) can be used to image the back of the eye, including the vitreous cavity, retina and choroidal layers of the eye wall.

Treatment depends on:

What caused the endophthalmitis ?
The state of vision in the affected eye ?

When the condition is caused by a bacterial infection, options include one or more of the following:

Intravitreal antibiotics. Antibiotics are injected directly into the infected eye. Usually, some vitreous is removed to make room for the antibiotic.

Corticosteroids. Ophthalmologist may inject corticosteroids into the eye. They will decrease inflammation and speed healing.

Intravenous antibiotics. Antibiotics may be injected into a vein. This may be prescribed for patients with severe infection.

Topical antibiotics. Antibiotics may be applied to the surface of the eye when there is a wound infection in addition to endophthalmitis.

Vitrectomy. Part of the eye's infected vitreous fluid is removed. It is replaced with sterile saline or another compatible liquid. This usually is done if vision loss is so severe that the person is nearly blind.

When the condition is caused by a fungal infection, doctors usually inject an antifungal medication directly into the infected eye. The medication may also be given intravenously. Or, the person may receive an oral antifungal drug.

Enucleation in case of painful blind eye.

Treatment of postoperative endophthalmitis Pars plana vitrectomy or vitreous aspiration may be performed by an ophthalmologist with administration of intravitreal antibiotics (ie, vancomycin, amikacin, ceftazidime).

Consider systemic antibiotic administration as well as intravitreal steroids.

Enucleation in case of painful blind eye.

The prognosis for visual recovery after endophthalmitis is variable. Patients who present early with less virulent organisms may do very well. Patients infected with very virulent organisms or after traumatic injury to the eye may have difficulty regaining much vision. In either case, the road to recovery is long, probably several weeks to months.

Complications:

Panuveitis or Panophthalmitis — Progression to involve all the coats of the eye.
Corneal ulcer
Orbital cellulitis
No light perception vision

AThe doctor will follow the patient frequently to make sure the infection is improving. It takes a long time for severe inflammation in the eye to clear up. The most important thing to do is to contact an eye doctor as soon as possible if any of the above symptoms occur, because injection of antibiotics should be done as promptly as possible.

The expense depends upon the grades of treatment.