Fig. 1.1
Clinical classification of endophthalmitis
Some of the definitions frequently used in endophthalmitis are listed in Table 1.1.
Table 1.1
Definitions of endophthalmitis
|
Category |
Name |
Comments |
|---|---|---|
|
Time [4] |
Acute |
Endophthalmitis presenting within 6 weeks of surgery |
|
Chronic |
Endophthalmitis presenting after 6 weeks of surgery | |
|
Symptoms and signs [5] |
Early |
An infection with relatively well-preserved media clarity, allowing good red reflex, occasionally even observing retinal details |
|
Delayed |
An infection with severe opacity in the anterior media, typically accompanied by severe vitreous infiltration or true abscess | |
|
Microorganism |
Bacterial |
Gram-positive and gram-negative organisms cause infection |
|
Fungal |
Nonfilamentous or filamentous fungi cause infection | |
|
Exogenous |
The infectious agent reaches the vitreous cavity through external injury, either after intraocular surgery or trauma | |
|
Endogenous |
The infectious agents reach vitreous cavity by hematogenous spread |
Signs and Symptoms
The classical symptoms of endophthalmitis are increasing pain and reduction in vision (Table 1.2). In the European Society of Cataract and Refractive Surgeons (ESCRS) study [3], the reduction of vision and pain accounted for 92.9% and 79% of all symptoms, respectively, and in the Endophthalmitis Vitrectomy Study (EVS) [4], it accounted for 94% and 74% of all symptoms, respectively. The other common symptoms are a swollen eyelid that usually occurs in infection by more virulent organisms. In the EVS, 82% complained of “red eye”; this symptom was not assessed in the ESCRS study. The commonest signs seen are hypopyon and lid edema. In the ESCRS study, hypopyon and lid edema accounted for 72% and 46% of all signs, respectively, and in the EVS, it accounted for 85% and 34%, respectively. Depending on the amount of corneal edema, pupillary membrane, and vitritis, the indirect ophthalmoscopy may not show a fundal glow but show a mild red glow, or it could be clear enough for visualization of the optic disk and blood vessels.
Table 1.2
Common signs and symptoms of endophthalmitis
|
Effects |
EVS (%) [4] |
ESCRS (%) [3] | |
|---|---|---|---|
|
Symptoms |
Decrease vision |
94 |
92.9 |
|
Pain |
74 |
79 | |
|
Lid edema |
34 |
46 | |
|
Red eye |
|||
|
Signs |
Lid edema |
85 |
72 |
|
Corneal edema |
|||
|
Hypopyon, anterior chamber fibrin |
|||
|
Vitreous cells
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