Page 112 - NAME OF CONDITION: REFRACTIVE ERRORS

Sterile inflammation may result from retained intraocular foreign material like cotton
fibers, from toxic reaction to drugs or irrigating fluids, from operative trauma, from

exacerbation of preexisting uveitis, and from other conditions like phacoanaphylactic
endophthalmitis and sympathetic ophthalmia. Post trauma or post cataract surgery severe
inflammation with true hypopyon can result from retained lens fragments.
Ultrasonography may be helpful in establishing the diagnosis. The clinical presentation
depends on cause, therefore the history may be helpful, and should include the details of
recent surgery, allergy history and uveitis history.

IV. PREVENTION AND COUNSELING

The mainstay of prevention of post operative endophthalmitis is maintenance of strict
surgical asepsis during any intraocular surgery. The ocular surface and adnexa are the
primary sources of microbes in culture positive cases of post operative endophthalmitis.
The use of topical 5% povidine iodine solution in the conjunctival fornices before

performing intraocular surgery reduces the bacterial load and decreases the incidence of
this condition. The second line of prevention is use of broad spectrum and bactericidial
topical / periocular/ intracameral antibiotics. Numerous surgical studies have confirmed
that prophylactic antibiotics are maximally effective preoperatively and less effective
postoperatively in preventing endophthalmits. In case of post operative endophthalmitis,
prompt referral to a tertiary care centre in case of slightest doubt is mandatory.
Investigations have to be immediately performed to rule out any intra ocular foreign body.

V. OPTIMAL DIAGNOSTIC CRITERIA, INVESTIGATIONS, TREATMENT
& REFERRAL CRITERIA

*Situation 1: At Secondary Hospital/ Non-Metro situation: Optimal

Standards of Treatment in Situations where technology and resources
are limited

a) Clinical Diagnosis:

The diagnosis of endophthalmitis is based on the clinical presentation, be it postoperative,
post-trauma or endogenous. Any eye with inflammation greater than the usual
postoperative or post-trauma clinical course should be suspected of having
endophthalmitis. Symptomatically, typically the patient notes a sudden increase in pain and

decrease in vision which may manifest after a variable time period after an intraocular
surgery or open globe injury. Examination demonstrates conjunctival chemosis and

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