Endogenous Endophthalmitis-The Clinical Significance of the Primary Source of Infection

Abstract

Endophthalmitis is a severe form of ocular inflammation. The source of pathogens in endogenous endophthalmitis is located inside the body, and infection spreads hematogenously. Although rare, endogenous endophthalmitis is a very serious condition, as this type of inflammation is very devastating for ocular tissues. Prognosis is very poor, and the patients are often in a serious general condition, so they require special care and an individual approach in the treatment process. Thanks to the knowledge of the risks associated with infections of individual tissues and organs as well as potential pathogens and the clinical picture, it is possible to make a correct diagnosis faster and implement the correct treatment. In the case of endogenous endophthalmitis, reaction time is absolutely crucial for prognosis. In this review, we focus primarily on the importance of the primary source of infection for the course of the disease and prognosis.

Keywords: bacterial endophthalmitis; endogenous endophthalmitis; endophthalmitis; fungal endophthalmitis; ocular infection.

Figure 1

Fundus pictures of subretinal abscess, taken on the second day after vitrectomy. Partially drained abscess is visible, located nasally from the optic disc. Poor image quality is caused by the presence of inflammatory cells in the anterior chamber.

Figure 2

Pre-operative photo of the anterior segment of the eye in the patient presented in Figure 1. Attention is drawn to the widening of the conjunctival blood vessels, damage to the corneal epithelium and cell deposits on the endothelium. Due to the poor transparency of optical centers, the view into the fundus was significantly impaired.

Figure 3

Tyndall in the aqueous humor causes a blurred image of the iris, especially visible below the pupil. In the lower part of the anterior chamber there is a hypopyon.

Figure 4

Hypopyon in the anterior chamber. Visible aggregates of inflammatory cells accumulated on the endothelium.

Figure 5

Posterior adhesions causing pupil irregularities. A slight hypopyon and ciliary congestion are also noteworthy.

Figure 6

Ultrasound B scan with a hyperechoic exudate filling almost the entire vitreous chamber. Advanced inflammation in a patient with bacterial EE.

Figure 7

Ultrasonography B scan with bacterial EE. As in Figure 6, hyperechoic densities fill the entire vitreous chamber. However, the lower intensity of the changes is noticeable.

Figure 8

Ultrasound B scans showing the evolution of changes during the development of inflammation. (A,B)—vitritis, posterior vitreous detachment (blue arrow), and retinal thickening. (C,D)—retinal detachment (green arrow) and numerous hyperechoic densities in the vitreous chamber (blue arrowhead).

Figure 9

Ultrasound examination showed hyperechoic densities and point tractions on the retina (blue arrowhead). Densities forms strands and membranes with reduced mobility (green arrowhead). In order to confirm that the retina is not detached, the A-scan was superimposed over B-scan.

Figure 10

Ultrasound B scan with numerous hyperechoic densities in vitreous chamber. The blue arrow marks a detached retina. Hyperechoic masses are visible under the retina.

Figure 11

Fundus photography of the left eye. Two white “cotton-like” spots on the surface of the retina. Attention is also drawn to small foci along the blood vessels (“strings of pearls”).

Figure 12

OCT examination of the patient presented in Figure 11. Scan through the retinal foci. There are also visible numerous densities in the vitreous.

Figure 13

OCT scan with extensive structural changes in the retina. Visible atrophic changes, the remodeling of the layers of the retina, and intraretinal edema in the temporal part.

Figure 14

Condition after vitrectomy with silicone oil endotamponade. Persistent edema of the macular area seen on OCT.

Figure 15

Photo of the optic nerve area, a vitreous chamber filled with silicone oil. Visible massive fibrous proliferation on the optic nerve disc and subretinal proliferations, lifting the retina.

Figure 16

OCT examination of the patient presented in Figure 15. Cross-section of the optic disc area. Visible retinal elevation due to the presence of fibrosis.

Figure 17

OCT examination of the patient presented in Figure 15. The macular area of the left eye. OCT shows tractional retinal folds, epiretinal membranes, cystic spaces, and disorganization of the retinal layers.

Figure 18

Typical picture of hypotony maculopathy in OCT-folds in the neurosensory retina and choroid.