Post-traumatic endophthalmitis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Post-traumatic bacterial endophthalmitis occurs following penetrating ocular injuries. Post-traumatic endophthalmitis associated with a greater variety of organisms. The most common isolated organisms include Gram-positive Staphylococcus epidermidis and Streptococcus (as a part of the normal skin flora and regularly contaminate open wounds). Bacillus cereus is ranked second and some cases are polymicrobial.[1][2]
Historical Perspective
Classification
Pathophysiology
Pathogenesis
Post-traumatic bacterial endophthalmitis occurs following penetrating ocular injuries. Following penetrating injury, the eye globe integrity disturbed. Penetrating ocular injuries are accompanied by infection at a much higher rate compere to ocular surgery. The broad prevalence range is due to factors such as:
- Presence of an intraocular foreign body
- Delay primary globe repair
- Location and extent of laceration of the globe
Post-traumatic endophthalmitis associated with a greater variety of organisms. The most common isolated organisms include Gram-positive Staphylococcus epidermidis and Streptococcus (as a part of the normal skin flora and regularly contaminate open wounds). Bacillus cereus is ranked second and some cases are polymicrobial.[1][2]
Causes
Post-traumatic bacterial endophthalmitis
Common causes of post-traumatic bacterial endophthalmitis include:[3][1][2]
- Gram-positive bacteria
- Bacillus cereus (most common particularly in the setting of an IOFB or soil contamination)
- Staphylococcus
- Streptococcus
- Clostridium (fulminant endophthalmitis)
- Gram-negative bacteria
- Klebsiella
- Pseudomonas (fulminant endophthalmitis)
- Polymicrobial
Post-traumatic fungal endophthalmitis
Common causes of post-traumatic fungal endophthalmitis include:
- Candida species
- Aspergillus species
- Paecilomyces species
- Fusarium species
- Dematacious fungi
Differentiating Post-traumatic Endophthalmitis from Other Diseases
Epidemiology and Demographics
The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. Post-traumatic endophthalmitis accounts for 25,000 to 31,000 cases per 100,000 individuals with endophthalmitis.
Prevalence and Incidence
- The incidence of post-traumatic endophthalmitis was estimated to range from 3.300 to 30,000 per 100,000 individuals with penetrating ocular trauma.[1][2]
- The incidence of post-traumatic endophthalmitis was estimated to range from 1,300 to 61,000 per 100,000 individuals with intraocular foreign body.[1][2]
Post-traumatic endophthalmitis accounts for 25,000 to 31,000 cases per 100,000 individuals with endophthalmitis.
Risk Factors
Common risk factors in the development of post-traumatic bacterial endophthalmitis include:[1][2]
- Retained intraocular foreign bodies
- Non-metallic intraocular foreign body (IOFB)
- Injury in a rural setting
- Delay in repair more than 24 hours
- Disruption of the lens
Screening
Natural History, Complications, and Prognosis
Natural History
Post-traumatic endophthalmitis is a medical emergency. If left untreated, It may lead to panophthalmitis, corneal infiltration, corneal perforation, and ultimately permanent vision loss.
Complications
Prognosis
Post-traumatic bacterial endophthalmitis is associated with particularly very poor visual outcome. Only 22% to 42% patients with post-traumatic bacterial endophthalmitis obtain a final visual acuity of 20/400 or better.[1][4]
Diagnosis
Diagnostic Criteria
History and Symptoms
Posttraumatic bacterial endophthalmitis may occur within hours after the trauma or up to several weeks after injury. Symptoms include decreased vision, pain greater than expected, and lid swelling.
Physical Examination
Laboratory Findings
Imaging Findings
X Ray
Plain film x ray is helpful for the detection of intra ocular foreign bodies (IOFBs) igiven the low cost and ease of interpretation. However, it may detection of only about 40% of intra ocular foreign bodies (IOFBs).
CT
Orbital CT scan is helpful for localization of metallic intra ocular foreign bodies (IOFBs) in the setting of trauma. [1][4]
MRI
Orbital MRI scan is helpful for localization of intra ocular foreign bodies (IOFBs) that may be radiolucent on CT in the setting of trauma. However, metallic IOFB must be excluded first.[1][4]
Ultrasound
On ocular ultrasonography, endophthalmitis may characterized by anterior vitreous haze echoes and retinochoroidal thickening.[3][1]
Other Imaging Findings
Orbital echography is helpful for assessment of vitreous opacification, presence of (IOFBs), status of the posterior hyaloid face, and retinal detachment in a patient with either post-traumatic endophthalmitis.[1][4]
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Kernt M, Kampik A (2010). "Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives". Clin Ophthalmol. 4: 121–35. PMC 2850824. PMID 20390032.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Essex RW, Yi Q, Charles PG, Allen PJ (2004). "Post-traumatic endophthalmitis". Ophthalmology. 111 (11): 2015–22. doi:10.1016/j.ophtha.2003.09.041. PMID 15522366.
- ↑ 3.0 3.1 Durand ML (2013). "Endophthalmitis". Clin Microbiol Infect. 19 (3): 227–34. doi:10.1111/1469-0691.12118. PMC 3638360. PMID 23438028.
- ↑ 4.0 4.1 4.2 4.3 Affeldt JC, Flynn HW, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD (1987). "Microbial endophthalmitis resulting from ocular trauma". Ophthalmology. 94 (4): 407–13. PMID 3495766.