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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