endophthalmitis

1. ENDOPHTHALMIT
IS

2. ENDOPHTHALMITIS
Inflammation of the inner coats ofeyeball
Especially ant and post.chambers
Ant. Or post uveitis
Endophthalmitis
Panophthalmitis

3. CLASSIFICATION
Endophthalmitis
Infective
Exogenous
Endogenous
20 from
surrounding
Non infective
Post
operative
Post
Tramatic
Phacoanaphylactic
Intra ocular tumor
necrosis

4. Classification

5. STERILE
ENDOPHTHALMITIS
Post operative sterile endophthalmitis
Intraocular lens
instruments
Post traumaticendophthalmitis
Phacoanaphylacticendophthalmitis
Intra ocular tumornecrosis

6. ACUTE BACTERIAL
ENDOPHTHALMITIS
Complication of intraocular surgery
Infective source-patient’s ownflora
Symptoms
 Severe ocular pain
 Redness
 Lacrimation
 Photophobia
 Loss of vision

7. SIGNS
•Lid edema
•Chemosis
•Corneal clouding

8. SIGNS
Hypopyon
Fibrin membrane inant.
chamber

9. SIGNS
Woundgaping
Yellowreflex
Retinalperiphlebitis
(early sign)

10. Investigations
Vitreous tap
•Topical anesthesia
•Trans conjunctively
•23-guage needle
•0.1ml aspirated
 Gram staining
 Sensitivity test
 culture

11. INVESTIGATIONS
Fundoscopy
B scan-Ultrasound

12. Differential diagnosis
Occult retention of lens cortex ornucleus
Hypopyon uveitis (Behcet’s orrifabutin)
Blebitis
Keratitis
Toxic anterior segment syndrome (TASS)

13. TREATMENT
ANTIBIOTICS
Intravitreal
VANCOMYCIN 1mg in 0.1ml + CEFTAZIDIME 2.25mg in 0.1ml
VANCOMYCIN 1mg in 0.1ml + AMIKACIN 0.4mg in 0.1ml
Topical
VANCOMYCIN or CEFAZOLINE
AMIKACIN or TOBRAMYCIN
Systemic
CIPROFLOXACIN
VANCOMYCIN
CEFAZOLINE

14. TREATMENT
STEROIDS
Intravitreal- DEXAMATHASONE(0.4mg in 0.1ml)
Topical – DEXAMETHASONE(0.1%)
Systemic –PREDNISOLONE

15. TREATMENT
Cycloplegics - 1% atropine
Antiglaucoma - Acetazolamide or Timolol

16. SURGICAL TREATMENT
PARS PLANAVITRECTOMY
• Two port
• Three port

17. Assess visual
acuity
Only light
perception
Early
vitrectomy with
intra vitreal anti
biotics
Hand
movements
perceived
Vitreous tap
and culture
and intra vitreal
antibiotics
Improves Doesnot
improve
Tap vitreous
and check
culture
Vitrectomy and
repeat culture

18. PANOPHTHALMITIS
Intense pururlent inflammation of whole eye
ball
Symptoms
Severe ocular pain n head ache
Complete loss of vision
Profuse watering
Purulent discharge
Marked redness and swelling

19. Proptosis and painful movement ofeyeball
Lidedema
chemosis
Corneal edema nclouding
Anterior chamber full ofpus
IOP
Globeperforation
Signs

20. COMPLICATIONS
Orbitalcellulitis
Cavernous sinus thrombosis
Meningitis

21. TREATMENT
Anti inflammatory nanalgesic
Broad spectrumantibiotic
Evisceration