endophthalmitis
Introduction
Introduction to intraocular inflammation Inflammation in the eye is infectious, non-infectious, granulomatous and non-granulomatous. Among them, infectious ocular inflammation (mostly non-granulomatous) and granulomatous sympathetic ophthalmia are the most serious. In the case of ocular trauma, in addition to the apparent disregard of function, most of the contents of the eye are lost, should be removed within 2 weeks after the injury to prevent the occurrence of sympathetic ophthalmia, we must try to save the eye that may retain useful vision, in short, Eyeball removal surgery after eye trauma should be very cautious, and must not be rushed. basic knowledge The proportion of illness: 0.005% Susceptible people: no special people Mode of infection: non-infectious Complications: cataract Glaucoma
Cause
Cause of intraocular inflammation
Causes:
Bacterial infection (20%):
Bacterial endophthalmitis is more common. There are many types of infected bacteria, such as Staphylococcus aureus, Streptococcus, Staphylococcus epidermidis, Proteus and Pseudomonas aeruginosa.
Drug factors (30%):
Fungal endophthalmitis can occur in ocular trauma, post-operative or endogenous. Intrinsic people often have predisposing factors such as infirmity, receiving immunosuppressive drugs or intravenous drug abuse. There are many types of fungi causing intraocular infections, including Candida albicans, Aspergillus, Rhodobacter, and Mucor.
Eyeball penetrating injury (10%):
Sympathetic ophthalmia (Synvathetic ophtbnlmia, SO) occurs mostly after eyeball penetrating injury, the wound is located in the limbus, ciliary area or transverse corneal injury, especially the uveal incarceration is easy to occur.
Occasionally, uveitis occurs after intraocular surgery or corneal ulcer perforation. The other eye often develops from 2 weeks to 2 months after injury. A few years later, uveitis occurs (called sympathetic eye). The clinical manifestations and histopathological changes of both eyes were basically similar.
Pathological mechanism
Histopathology Eye puncture injury or internal eye surgery, most of the anterior segment of the eye is involved, and then spread to diffuse endophthalmitis, inflammatory features are suppurative, the affected tissue has polynuclear leukocytes and lymphocytes infiltration, not timely treatment, Pupil obstruction, complicated cataract, secondary glaucoma, long-term inflammation in the eye, and ultimately eyeball atrophy.
Fungal endophthalmitis
Single or multiple abscesses can be seen in front of the vitreous or in the vitreous. There are inflammatory cell infiltration and necrosis, and spores or hyphae can be found in necrotic tissue. The mycelium of Mucor is large, without separation, and has a right-angled branch. The hyphae of Aspergillus are finer, separated, and the branches are acute.
Sympathetic ophthalmia
Early (about 2 weeks) is non-granulomatous inflammation, choroid has small lymphocytes infiltration, no plasma cells. A typical change is uveal granulomatous inflammation. Light microscopy showed iris, ciliary body and choroidal thickening, in which diffuse lymphocytes infiltrated, occasionally plasma cells, epithelioid cells. It can invade the anterior chamber angle, trabecular and Xu's tube, which is the pathological basis of secondary I glaucoma. And there are multiple layers of lymphocytes around the blood vessels.
In the infiltration of ciliary body and choroidal lymphocytes, epithelioid cells can be aggregated into nodules, in which cells that phagocytose melanin and multinucleated giant cells are seen, and epithelial cells of the outer layer of the retina aggregate to form Dalen-Fuch nodules. There are also atypical histological changes, including retinal, papilledema, lymphocytes infiltrating or surrounding the blood vessels. Lymphocytes can infiltrate the scleral parenchyma, infiltrate the nerves, and can also invade the surrounding ciliary vessels, causing irregularities in the lumen of the blood vessels, and even vascular occlusion.
Prevention
Endophthalmitis prevention
In the case of ocular trauma, in addition to the apparent disregard of function, most of the contents of the eye are lost, should be removed within 2 weeks after the injury to prevent the occurrence of sympathetic ophthalmia, we must try to save the eye that may retain useful vision, in short, Eyeball removal surgery after eye trauma should be very cautious, and must not be rushed.
Complication
Endophthalmitis complications Complications cataract glaucoma
Pupil obstruction, complicated cataract, secondary glaucoma, long-term inflammation in the eye, and eventually eyeball atrophy.
Symptom
Symptoms of inflammation in the eyeball Common symptoms Inflammatory keratitis Uveitis Corneal ulcer Optic papilledema
First, intraocular inflammation
Endophthalmitis is an intraocular inflammation caused by a penetrating injury to the eye, a septic keratitis or an endogenous (metastatic) bacterial or fungal infection after intraocular surgery.
(1) Bacterial endophthalmitis
More common, there are many types of infected bacteria, such as Staphylococcus aureus, Streptococcus, Staphylococcus epidermidis, Proteus and Pseudomonas aeruginosa.
(two) fungal endophthalmitis
Can occur in ocular trauma, postoperative or endogenous, endogenous often have predisposing factors such as infirmity, receiving immunosuppressive drugs or intravenous drug abuse, etc., causing more intraocular infections, including white candida, Aspergillus, crescents, mucor and so on.
Second, sympathetic ophthalmia
Sympathetic ophthalmia (Synvathetic ophtbnlmia, SO) occurs mostly after eyeball penetrating injury, the wound is located in the limbus, ciliary area or transverse corneal injury, especially the uveal incarceration is easy to occur.
Occasionally, uveitis occurs after intraocular surgery or corneal ulcer perforation. Another eye often develops from 2 weeks to 2 months after injury. A few years later, uveitis occurs (called sympathetic eye), clinical manifestations and histopathology of both eyes. The changes are basically similar.
Examine
Eyeball inflammation check
1. History of ocular trauma and surgery, history of sexually transmitted diseases, history of dyspnea.
2. Comprehensive eye examinations include dilated eye examinations.
3. Complete blood count, RPR, FTA-ABS; if considering sarcoma, measure ACE levels.
4. Chest X-ray to exclude tuberculosis or sarcoma.
5. Fundus fluorescein angiography or B-ultrasound examination.
Diagnosis
Diagnosis of intraocular inflammation
Diagnostic criteria
First, intraocular inflammation
Endophthalmitis is an intraocular inflammation caused by a penetrating injury to the eye, post-operative eye surgery, purulent keratitis, or endogenous (metastatic) bacterial or fungal infection.
Second, bacterial endophthalmitis
More common. There are many types of infected bacteria, such as Staphylococcus aureus, Streptococcus, Staphylococcus epidermidis, Proteus and Pseudomonas aeruginosa.
Differential diagnosis
1. For those who have a history of trauma and another eye with irritation, try to eliminate the primary lesion.
2, exclude crystal uveitis, uveal encephalitis (VKH): they have common points that are difficult to identify, but also have their own characteristics.
3. Identification with Behcet's syndrome (behcet's disease).
