Endogenous endophthalmitis
A 44-year-old man with diabetes mellitus and end-stage kidney disease arrived to the emergency department complaining of pain and fuzzy vision in his left eye, fevers, and back pain for two weeks. Conjunctival injection and corneal clouding in the left eye were discovered during an ophthalmologic examination. Visual acuity in the right eye was 20/60, whereas light sensitivity in the left eye was low. A slit-lamp examination revealed a cloudy, edematous cornea in the left eye, as well as a tiny hypopyon. Methicillin-sensitive Staphylococcus aureus thrived in vitreous fluid and blood cultures. Bacterial endogenous endophthalmitis was diagnosed. Endophthalmitis is a potentially blinding infection of the eye’s vitreous and aqueous fluids.
Endogenous endophthalamitis can be a medical emergency and cause permanent vision loss
When an illness spreads through the bloodstream, it is considered endogenous. Endogenous endophthalmitis cannot be treated effectively with systemic antibacterial medicines alone. In situations of severe vision loss or infection progression despite antimicrobial therapy, intravitreal antimicrobial therapy is indicated, and vitrectomy is indicated. Further imaging revealed paraspinal muscle abscesses and mitral valve endocarditis in this instance. Intravitreal antibacterial drugs and an 8-week course of intravenous cefazolin were administered. Because of the late clinical manifestation, a vitrectomy was not performed. The patient’s vision had not improved after a 2-month follow-up appointment.
Endogenous endophthalmitis is a medical emergency that can result in serious vision loss. It is frequently difficult to diagnose because it can appear at any age and is related with a number of underlying risk factors. Microorganisms connected with this illness span a wide range. Medical and surgical procedures may be used depending on the severity of the sickness. Due to the disease’s rarity, there are no guidelines in the literature for appropriate therapy of these patients. Treatment guidelines based on clinical data and microorganism profiles have been proposed in this review.
Endophthalmitis is an intraocular infection that affects the inner layers of the eye and is characterised with substantial, progressive vitreous inflammation
Endophthalmitis is a medical emergency that can have devastating ocular and systemic consequences. The most typical way for infective organisms to enter the body is through an external wound, such as trauma, surgery, or an infected cornea. Exogenous endophthalmitis refers to certain cases of endophthalmitis. Endogenous endophthalmitis (EE) is caused by the hematogenous transmission of bacteria from distant locations.
EE accounts for roughly 2-8% of all endophthalmitis patients. Due to the disease’s scarcity, most EE literature consists of case series or single case reports. In contrast to exogenous endophthalmitis, demographics, treatment choices, and outcome measures in EE patients have not been examined on a wide scale.
In 1856, the first instance of bacterial EE was published. Following that, a large review with around 335 instances of bacterial EE was published in 2003, and the authors have recently updated their initial data to include new reports. However, there have been no large reviews in the literature that cover all of the infectious aetiologies, including both bacterial and fungal infections. A comprehensive review of EE is required due to shifting patterns of microbial disease epidemiology, re-emergence of some infectious illnesses, antibiotic susceptibility, and the creation of superbugs.
Prognosis
The outlook for endogenous endophthalmitis depends on several factors such as the time of presentation, clinical symptoms, the degree of vitreous involvement, and the aggressiveness of the infecting microorganism. Diagnosis of this condition is intricate, often leading to delayed detection due to various underlying health conditions. Research indicates that yeasts generally have the best prognosis, followed by bacteria, with molds associated with the least favorable outcomes.
Patients who are diagnosed late or experience delays in treatment often face complete vision loss and have a generally poor prognosis. Those requiring a vitreous tap are at increased risk of retinal detachment, which further impacts their outlook. Zenith et al. observed that bacterial endogenous endophthalmitis (EE) tends to have a worse prognosis compared to fungal EE, sometimes necessitating enucleation or evisceration. Conversely, Yonekawa et al. demonstrated that timely diagnosis and treatment improved visual outcomes in a significant percentage of bacterial EE cases, with 64% achieving better than counting finger vision.
Itoh et al. highlighted that early and aggressive vitrectomy within two weeks of diagnosis led to positive final outcomes, indicating a favorable prognosis in such cases. Among specific microorganisms, MRSA-associated EE has been linked to poorer outcomes and higher mortality rates, although the relationship may vary across different studies. Connell et al. noted that many Klebsiella EE cases necessitated vitrectomy, while Ang et al. found hypopyon in Klebsiella EE to be a predictive factor for prognosis.
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