What Are the Most Common Causes of Inflammation of the Eyeball?

Endophthalmitis is an intraocular inflammatory reaction caused by perforation of the eyeball. After intraocular surgery, purulent keratitis or endogenous (metastatic) bacterial or fungal infections. Intraocular inflammation is infectious, non-infectious, granulomatous, and non-granulomatous. Among them, infectious endophthalmitis (mostly non-granulomatous) and granulomatous sympathetic ophthalmitis are the most serious.

Basic Information

Visiting department

Ophthalmology

Common locations

eye

Common causes

Eye penetrating injury, caused by purulent keratitis or endogenous (metastatic) bacterial or fungal infection after internal eye surgery

Contagious

no

Causes of endophthalmitis

Bacterial endophthalmitis

See you most. There are many types of bacteria infected, such as Staphylococcus aureus, Streptococcus, Staphylococcus epidermidis, Proteus and Pseudomonas aeruginosa.

2. Fungal endophthalmitis

It can occur from eye trauma, after surgery, or endogenously. Endogenous people often have predisposing factors such as frailty, receiving immunosuppressive drugs or intravenous drug abuse. There are many types of fungi that cause eye infections, including Candida albicans, Aspergillus, Crescentia, Mucor and so on.

3. sympathetic ophthalmia

Sympathetic ophthalmitis usually occurs after a penetrating injury on one side of the eye. The wound is located on the limbus, the ciliary area or the transverse corneal injury, especially in those with uveal impaction. Uveitis occasionally occurs after surgery of the inner eye or perforation of the corneal ulcer. The other eye usually develops from 2 weeks to 2 months after the injury, and a few years later, uveitis (called sympathetic eye) occurs.

Clinical manifestations of endophthalmitis

Bacterial endophthalmitis

After perforation injury or intraocular surgery, most of the anterior segment of the eye is affected first, and then diffuses into diffuse endophthalmitis, which is characterized by purulent inflammation, multinucleated white blood cells and lymphocyte infiltration in affected tissues, and pupil obstruction may occur if not treated in time. Complicated cataract, secondary glaucoma, long-term inflammation in the eye, and eventually atrophy of the eyeball.

2. Fungal endophthalmitis

Single or multiple abscesses can be found in front of the vitreous or in the vitreous, with infiltration and necrosis of inflammatory cells, spores or hyphae can be found in necrotic tissue, thick hyphae of mucormyces, no division, right-angled branches, hyphae of aspergillus It is thin, separated, and the branches are at acute angles.

3. sympathetic ophthalmia

The clinical manifestations and histopathological changes of both eyes were basically similar. Early (onset in about 2 weeks) is non-granulomatous inflammation, choroids infiltrated with small lymphocytes, no plasma cells, typical changes to uveal granulomatous inflammation, light microscope can see thickening of iris, ciliary body and choroid, among which Diffuse lymphocytic infiltration, occasionally plasma cells, epithelioid cells, can invade the anterior chamber angle, trabecula and Xu's canal around. This is the pathological basis of secondary glaucoma, and there are multiple layers of lymphocytes surrounding the blood vessels.

In the infiltration of ciliary body and choroidal lymphocytes, epithelial-like cells aggregated into nodularity. Among them, melanin-phagic cells and multinucleated giant cells were seen. Outer retinal epithelial-like cells aggregated to form Dalen-Fuch nodules. Changes, including retinal and papillary edema, lymphocyte infiltration or surrounding blood vessels, lymphocytes can infiltrate the scleral parenchyma, infiltrate nerves, and invade the posterior ciliary vessels, causing irregular vessel lumen and even vascular occlusion .

Endophthalmitis examination

Medical history

History of ocular trauma and surgery, history of sexually transmitted diseases, history of dyspnea.

2. Comprehensive eye examination

Including mydriasis and fundus examination.

3. Whole blood cell count

RPR (rapid plasma reagin test), FTA-ABS (fluorescent treponemal antiboby, absorbed (syphilis) fluorescence Treponema antibody absorption test); if considering sarcoma, measure ACE (angiotensin converting enzyme angiotensin converting enzyme )Level.

4. Chest X-ray

To rule out tuberculosis or sarcomatoid disease.

5. Fundus fluorescein angiography or B-ultrasound

Endophthalmitis treatment

Treatment principle

Once diagnosed, the pupils are dilated in time, inflammation is controlled, and comprehensive treatment is performed.

2. Corticosteroids

First of all, the drug is corticosteroids. Ornixon is administered orally every morning. After that, it can be administered every other day depending on the severity of the disease. After the inflammation subsides, it should be continued for several months. Do not stop it or reduce the dose in advance.

3. Immunosuppressive

Hormonal therapy or those who cannot continue to use, can use immunosuppressants such as fuconine or cyclophosphamide.

4. Antibiotic adjuvant therapy

Local and systemic antibiotics and adjuvant therapy.

5. Surgical treatment

Bacterial endophthalmitis should be performed as soon as possible, and antibiotics should be applied throughout the body. Vitreous injection can be performed first for vitrectomy as soon as possible.

Sympathetic ophthalmitis stimulates the eyes after early active treatment, and those who have completely lost vision should be removed early. If it is possible to restore vision, the eyes should still be actively rescued.