Page 111 - NAME OF CONDITION: REFRACTIVE ERRORS

I. WHEN TO SUSPECT/ RECOGNIZE?

a) Introduction:

Exogenous Endophthalmitis is a devastating complication, usually following intraocular
surgery or open globe injury. Rarely, a hematogenous dissemination into the eye from a
distant focus of injection within the body may be a cause and this form is termed as
endogenous endophthalmitis in this condition, the internal structure of the eye are

invaded by replicating microorganisms, resulting in an inflammatory response that
ultimately may involve all tissues of the eye. This serious condition can be effectively
treated if diagnosed early and treated comprehensively.
b) Case definition:

Endophthalmitis is defined as a serious intraocular inflammation resulting from
infection of the vitreous cavity. Exogenous endophthalmitis occurs when infective
organisms gain entry into the eye by direct inoculation, such as from intraocular
surgery, intravitreal injections, penetrating trauma, or contiguous spread from adjacent
tissues. Endogenous endophthalmitis occurs when infectious agents are

hematogenously disseminated into the eye from a distant focus of infection. Initial
intraocular signs and symptoms may include decreased visual acuity, afferent pupillary
defect, pain, hypopyon, fibrinoid anterior chamber response, corneal edema,
corneal/wound infiltrate, vitreous inflammation, retinitis, and/or retinal periphlebitis.
External signs of inflammation, such as ciliary injection, chemosis, and lid edema, may
be present. If the infection has spread to orbit, restriction of extraocular motility and
proptosis may occur.

II.INCIDENCE OF THE CONDITION IN OUR COUNTRY

The national survey on blindness and visual outcome after cataract surgery in 2001,
carried out by the ministry of health, Government of India, found an incidence of 0.6%.
In a study conducted by a major tertiary care centre, the incidence of post operative
endophthalmitis was found to be 0.09%. Traumatic endophthalmitis accounts for
approximately 7% of open globe injuries and nearly a quarter of all endophthalmitis

cases. Endogenous endophthalmits accounts for 2.6% of all culture positive
endophthalmitis.

III. DIFFERENTIAL DIAGNOSIS:

The following are the differential diagnosis
a) Sterile uveitis

b) Phacoanaphylactic endophthtalmitis

c) Sympathetic ophthalmia

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