Endogenous endophthalmitis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Endogenous endophthalmitis (EE) also termed metastatic endophthalmitis, is caused by the hematologic dissemination of bacterial or fungal infection to the eyes. Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection. Endogenous endophthalmitis is less common than exogenous endophthalmitis and has been reported to account for 2–8%.

Historical Perspective

Classification

endogenous enophthalmitis may be classified according to causative organisms into 2 subtypes: bacterial or fungal.

Pathophysiology

Pathogenesis

Endogenous endophthalmitis is caused by the hematologic dissemination of an infection to the eyes. Most common extraocular foci of infection include liver abscess, pneumonia, endocarditis, and soft tissue infection. Endogenous endophthalmitis is commonly associated with immunosuppression or procedures that increase the risk for blood-borne infections, such as diabetes, HIV, malignancy, intravenous drug use, transplantation, immunosuppressive therapy, and catheterization. Under normal circumstances, the blood-ocular barrier provides a natural resistance against invading organisms. Following bacteremia, the blood-borne organisms permeate the blood-ocular barrier by:[1][2][3]

Direct spread from contagious sites can also occur in cases of central nervous system (CNS) infection via the optic nerve.

The exact pathogenesis of candida endophthalmitis is not fully understood. It is though endogenous candida endophthalmitis is commonly associated with abdominal surgery or diabetes mellitus. It is thought immunosuppression alone does not increase the risk of fungemia and subsequent fungal endophthalmitis.

The asexual spores of aspergilli organisms are airborne. Following inhalation of an airborne organism into the body, the aspergilli spores enter the terminal alveoli of the lung. Under normal circumstances, the lung provides a natural resistance against invading organisms. But in high risk patients, such as those patients with history of chronic pulmonary diseases], history of organ transplant, intravenous drug abuse, cardiac surgery, and alcoholism, disseminated aspergillosis may result in endogenous endophthalmitis.

Gross Pathology

On gross pathology, eyelid swelling, eyelid erythema, conjunctival injection, chemosis, and mucoprulunt dischage are characteristic findings of endogenous endophthalmitis.

Microscopic histopathological analysis

  • On microscopic histopathological analysis, infiltration of polymorphonuclear leukocytes and destruction of ocular structures are characteristic findings of endogeouse bacterial endophthalmitis.
  • On microscopic histopathological analysis, random vitreouse and retinal lesions with polymorphonoclear leukocytes, lymphocytes, budding yeast, pseudohyphae, and choroidal/retinal wall invasion are characteristic findings of candida endophthalmitis.
  • On microscopic histopathological analysis, angiocentric retinal and choroidal lesion, mixed acute and chronic inflammatory cells infiltration, retinal and choroidal vessel invassion, subretinal pigment epithelial and subretinal infection are characteristic findings of aspergillus endophthalmitis.[2][3]

Bacterial

Fungal

Differentiating endogenous Endophthalmitis from Other Diseases

  • Cytomegalvirus retinitis
  • Toxoplasmosis retinochoroiditis
  • Coccidiomycosis choroiditis
  • Bacterial endophthalmaitis

Epidemiology and Demographics

Risk Factors

Endogenous bacterial endophthalmitis

Common risk factors in the development of endogenous bacterial endophthalmitis include:[1][2][3]

Endogenous fungal endophthalmitis

Common risk factors in the development of endogenous fungal endophthalmitis include:

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

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CT

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Treatment

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Prevention

References

  1. 1.0 1.1 Durand ML (2013). "Endophthalmitis". Clin Microbiol Infect. 19 (3): 227–34. doi:10.1111/1469-0691.12118. PMC 3638360. PMID 23438028.
  2. 2.0 2.1 2.2 Kernt M, Kampik A (2010). "Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives". Clin Ophthalmol. 4: 121–35. PMC 2850824. PMID 20390032.
  3. 3.0 3.1 3.2 Wong JS, Chan TK, Lee HM, Chee SP (2000). "Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction". Ophthalmology. 107 (8): 1483–91. PMID 10919895.


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