Endophthalmitis: causes and treatment

Usually, eye diseases affect the outer and (rarely) internal eye membranes, as the elements most often affected by adverse environmental factors. These are numerous conjunctivitis, keratitis, iridocyclitis, etc. defeat. However, in rare cases of penetration of infectious agents into the eye structures, inflammation can affect the vitreous humor.

Definition of disease

The human eye is 2/3 filled with a biological substance that has a gel-like structure.This is a vitreous body, which is 99% water. The main component in the biological gel is hyaluronic acid, which imparts to the substance gel state and, in addition, fulfilling a number of important functions: regenerating, anti-inflammatory, etc.

The vitreous body is covered with a membrane that fits snugly from inside to the scleral tissues.The biological gel is one of the light-refracting media of the eye and provides it with an incompressible elastic form.

The vitreous body itself can not be affected, however, when the surrounding envelopes surrounding it, purulent exudate penetrates the eyeball, causing endophthalmitis.

Structure of the eye

Causes

Inflammation with the formation of pus can occur within the eye only when entering an infection of bacterial origin:

• Staphylococci, streptococci;
• Corynebacterium, Proteus;
• Klebsiella, enterobacteria, and others.

In addition, their combinations and fungi of the genus Candida sometimes act as an infectious agent.

Penetration of the pathogen can be triggered by a number of reasons:

• Exogenous:at mechanical traumas, burns, penetration of a foreign body, in the post-operation period;
• Endogenous: as a result of hematogenous infection when microbes are introduced into the vessels of the eye tissues from foci of a systemic infection.

One of the decisive factors in the activation of any inflammatory process in the body is a lowered level of immunity.

Symptoms

The initial symptoms of endophthalmitis are directly related to the violation of the photophobia of the vitreous. Therefore it is noted:

• Impairment of vision quality;
• There are pain in the eye,redness and swelling of the eyelids;
• There is moderate hyperemia of the eyelids and conjunctiva;
• When examining the lens, floating haze is observed, which subsequently assume shades of yellow.

With progressive endophthalmitis, an abscess is formed in the vitreous humor, resulting in a yellowish color in the pupil. In rare cases, there are: a change in the color of the iris, an increase in IOP, a profuse suppuration, a pupillary deformity.

Depending on the extent of inflammation, several forms of the pathological condition are distinguished:

• Focal- changes affect only the damaged part of the eye, causing a mild degree of vision loss;
• Diffuse- the inflammation spreads over the entire volume of the vitreous, which is accompanied by a violation of the patency of light rays;
• Mixed- when the process spreads to the entire vitreous body, a local zone is observed where the vitreous body melts.

The disease can occur in acute and chronic form. In chronic inflammation, the first signs can appear no earlier than a year after infection.

Possible complications

By itself, endophthalmitis is a fairly formidable disease, not always amenable to treatment.And ignoring the symptoms or incorrect treatment can lead to the development of a number of severe eye pathologies:

• Retinal disinsertion- the shell, located between the vitreous body and the choroid. With detachment, visual perception is disturbed, the result can be complete or partial blindness;
• Recurrent uveitis- inflammation of the vascular membranes of the eye, accompanied by periodic relapses and affecting the iris, ciliary body, choroid;
• Atrophy of the eyeball- severe inflammatory lesion, accompanied by a decrease in the size of the eyeball and most often leading to blindness;
• Panophthalmite- purulent inflammation, affecting all eye structures and sometimes turning to bone tissue;
• Meningitis- Inflammation of the meninges, its terrible complication - encephalitis. Both pathologies carry a potential death threat;
• Complete blindness- develops as a result of complete destruction of functional eye systems or the need to remove the eyeball.

  Detachment of the retina

Endophthalmitis in the development of complications threatens not only the loss of vision, but also human life. Therefore, its treatment should be, of course, only medicated and carried out as soon as possible.

Treatment

For a full-fledged diagnosis, the usual studies are conducted:

• Visometry- determination of the degree of visual acuity;
• Biomicroscopy- examination using a slit lamp;
• Tonometry- measurement of intraocular pressure;
• Perimetry- study of visual fields;
• Ultrasound of the eyeball- a method of visual assessment of the eye and adjacent areas.

  Carrying out the visometry

During the examination, the doctor can detect an expansion of the blood vessels in the conjunctiva, sclera or iris, adhesions between the anterior surface of the lens and the iris, opacity in the vitreous body.

Medication Therapy

Treatment of endophthalmitis is always complex and urgent, as the infection can spread not only to the eye shells and orbit, but also to go beyond the eye.Therefore, mandatory appoint complex treatment:

• Antibiotics:Penicillin, Levomycetin, Erythromycin, Neomycin, Gentamicin. It is practiced as a systemic introduction (intramuscularly, intravenously), and locally (retrobulbarno or in the form of instillations);
• Anti-inflammatory:Ibuprofen, Indomethacin, corticosteroids;
• Antihistamines- to reduce sensitization (sensitivity) and detoxification of the body;
• Enzymes:Trypsin, Lydas. Used to eliminate fibrinous films and the appearance of adhesions in the retina.

  Levomycetin is used to treat endophthalmitis

To maintain the whole organism as a whole, vitamin complexes and special eye vitamins can be used.

However, in the treatment of any purulent process, the main element of therapy is the creation of conditions for the outflow of pus, since it is the source of infection. In the case of conservative treatment of endophthalmitis, the decay products do not disappear anywhere, so often for treatment of the disease the only way to stop the infection is surgical treatment methods.

Surgically

For effective treatment of endophthalmitis, a modern technique is used - vitrectomy, an operation to remove the vitreous. Operative intervention is carried out in the following order:

• In the region of the flat part, 3 cuts with a width of 4 mm are made.One is used to introduce the irrigation system, the other two are used for medical manipulation (introduction of a light guide and a vitreoretinal instrument);
• In the course of an operation, the duration of which depends on the severity of the lesions, the vitreous is replaced by one of the substitutes: balanced saline solution, liquid or gaseous perfluoroorganic compound, silicone oil, sterile air;
• Saline solutions and gas over time replaced by the produced intraocular fluid, so their replacement is not required. PFOS is used only for up to 10 days, and a silicone vial can remain in the cavity of the orbit until several years;
• When the vitreous body is replaced, its cladding extends and densely retracts to the retina, after which the surgeon soldered the laser shell in several places to the inner surface of the eye.

  Carrying out a vitrectomy

The operation can be performed on an outpatient basis and lasts up to, hours. In the case of tamponade PFOS at the end of the operation, it is replaced with physiological saline or other artificial filler.

The final stage of vitrectomy is the X-shaped vicryl suture,as well as subconjunctival injections with an antibiotic and a glucocorticosteroid.

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Prevention

Prevention of the development of the inflammatory process in the vitreous body is completely dependent on the penetration and activation of pathogenic microflora inside the eyeball.And this includes the following preventive measures:

• Prevention of mechanical, physical, chemical injuries of the eye;
• Prevention of foreign body penetration;
• Adequate antimicrobial treatment with penetrating wounds of the eye;
• Correct conduct of operative manipulations and postoperative treatment;
• Timely treatment of systemic inflammation foci in the body.

Like any disease, endophthalmitis has the most favorable prognosis with the earliest diagnosis and use of various treatment methods.

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conclusions

Endophthalmitis is one of the most serious infectious lesions of the eye, often endangering not only the vision, but also the risk of spreading the infection to the surrounding structures.

To minimize the possibility of severe consequences with progression of endophthalmitis, maximum caution in potentially dangerous situations: welding, metal cutting, extreme sports, dangerous professional activities.

Do not forget about the possibilities of immunity, general and local. It is he, not the pill, injections and drops, which, in the final analysis, is the real protector of the body from all kinds of infections. Therefore, "please" him as often as possible with garlic and onions, spinach and broccoli, cranberries and blueberries. Then, the recovery capabilities of the body and, in particular, the eyes will strengthen and become helpers in the fight against disease.

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