Bacterial and Fungal Endophthalmitis

Abstract

Endophthalmitis is a severe eye infection that may result in permanent loss of useful vision in the affected eye. Most cases are exogenous and occur as a complication of cataract surgery, an intravitreal injection, or penetrating ocular trauma. Endogenous endophthalmitis results from hematogenous seeding of the eye by bacteria or fungi, but bacteremia or fungemia may be transient and patients may present without symptoms of systemic infection. Nearly all endophthalmitis patients present with decreased vision, and some also have eye pain. Eye examination usually reveals a hypopyon and intraocular inflammation. Diagnosis is clinical, supported by cultures of the vitreous and/or aqueous or by blood cultures in some endogenous cases. Molecular diagnostic techniques have been used in research laboratories for pathogen identification in endophthalmitis and offer the possibility of rapid diagnosis, including in culture-negative cases. Intravitreal injection of antibiotics is the most important component of treatment; some cases also benefit from surgical debridement of the vitreous by a vitrectomy. The visual outcome depends partly on the pathogen: coagulase-negative staphylococcal endophthalmitis has a better prognosis than does streptococcal endophthalmitis, for example. Endophthalmitis is a medical emergency, and prompt diagnosis and treatment are essential for saving vision.

Candida Species From Eye Infections: Drug Susceptibility, Virulence Factors, and Molecular Characterization

“…Notwithstanding the procedure of identification and contrary to earlier reports of C. albicans being the most common yeast in eye infections 28,29 this study confirms that C. parapsilosis is more commonly associated with eye infections compared with all other species. Most studies reporting yeast eye infections have found C. parapsilosis a close second to C. albicans.…”

Demystifying Orbital Emergencies: A Pictorial Review

“…Most cases of endophthalmitis are exogenous and are due to direct inoculation of organisms into the globe from trauma or ocular surgery or are an extension of corneal infection that seeds the aqueous humor before spreading into the vitreous humor (13). Less commonly, endogenous endophthalmitis ( Fig 5) is due to organisms that seed the highly vascular choroid first before extending into the vitreous humor.…”

Orbital Imaging

“…Clinical features include eye pain, decreased vision, and red eye. 99,100 Progression may be rapid. For example, certain pathogens such as Bacillus cereus may result in complete vision loss in the affected eye within 24 to 48 hours.…”