Definition

Endoftalmitis is inflammation of the inside of the eye, generally due to infection. These infections can come from within the body or outside the body, but often post-eye surgery such as surgery katarakThe endoftalmitical event rate after the cataract operation ranged between 0.08-0.68% and this number compiled about 60% of the entire endoftalmitist case. Meanwhile, endogenous infections (from within the body) are rare, only about 2-15% of the whole endoftalmitist case.

Cause

Endoftalmitis can occur due to bacterial or fungal infections. Bacteria that are the most endoftalmist cause are positive Gram bacteria such as Staphylococcus epidermidic and Staphylococcus aureus in postoperative cases, as well as negative Gram bacteria such as Pseudomonas, Escherichia coli, and Enterococcus on a stab wound. Meanwhile, the most common cause of the fungus is Candida albicans.

Infections can be endogenous (from within the body) or exogenous (from the outside of the body). In normal circumstances, the eye ball has a defense system to prevent the entry of bacteria or fungi. In endogenous infections, bacteria or fungi can enter the eye by damaging the eye's bloodsheet directly or removing substances that change the structure of the inner lining of the blood vessels. Meanwhile, in exogenous infections, bacteria and fungi can enter the eye ball due to trauma, foreign objects, surgery, or injection of drugs into the eye's sphere.

In addition to infection, endoftalmitis can also be caused by toxic agents and the rest of the lens after cataract surgery.

Risk Factors

Endogenous endoftalmitis risk factors are infections in other parts of the body such as:

• Endocarditis (inflammatory parts of the heart)
• Meningitis (brain membranes)
• Urinary tract infection
• Decline in the body's immune system due to HIV/AIDS
• Diabetes mellitus
• The use of immune-reducing drugs in the long term

Meanwhile, exogenous endoftalmitist risk factors are:

• Eyeball stab wounds
• Cataract operating history (especially in 1 week after surgery)
• Drug injection into the eye ball
• Exposure to toxic compounds

Symptoms

In general, people suffering from endoftalmitis will complain of red and opaque eyes. In addition, complaints of pain in the eyes, headache, fever, glare, and the presence of fluids such as pus come out of the eyes are common. Usually, endoftalmitis only occurs in one eye ball.

In postoperative cases, infections occur most frequently within 1 week after surgery, but do not rule out the possibility to occur within a few months or years later. In endoftalmitis due to bacteria, complaints that often appear are pain in the eyes, red eyes, swollen petals, and a decrease in the sharpness of acute vision. 

Meanwhile, in endoftalmitis due to mushrooms, complaints that can be found can be in the form of blurred vision and pain that lasts for several days to several weeks. In fungal infection Candida, fever can precede symptoms in the eye ball.

Diagnosed

Endoftalmitis diagnosis can be done by doctors. Doctors will check the sharpness of the vision, pressure of the eye, as well as the examination of the outer and inner eye spheres. Examination of the outer eye sphere aims to see the swelling of the eyelids, injection or appearance of blood vessels in the eyes, as well as the presence of hypoions (layers such as pus in the front eye sphere). Examination of the inner eye ball can be done using funduscopy or slit lamp. The goal is to determine if the fluid in the eye is cloudy or clear, as well as a decrease in the red reflectance. During this examination, it can also be found that there are points such as cotton and debris in the fluid in the eye.

In addition, doctors will order several other checks to support diagnosis, such as:

• The blood count is complete with a count of the type to enforce an infection
• Spherical fluid culture to determine the agent that causes infection

Some of these examinations will be carried out in accordance with the symptoms of comorbidities:

• Examination of kidney function if there is a history of kidney disease or diabetes
• Photos of the heart tox and ultrasound if suspected of having an infection in the heart
• Certificates of cerebrospinal fluid if suspected of infection in brain membranes
• Blood curves if there is a fever caused by an infection that is known or not known
• Currency swab culture if suspected of throat infection
• Kultur a foreign object that causes stab wounds if you have a history of stabbing on the eye ball
• Urine culture if suspected of urinary tract infection or unknown origin of the infection
• Fecess culture if suspected of digestive infection

Laksana Procedure

Endoftalmitis management will depend on the agent's causes and risk factors. In general, endoftalmitis' main therapy is the administration of antibiotics. In the postoperative case, treatment can be done by removing fluids in the infected eye sphere accompanied by giving antibiotics into the eye. In the case of trauma, surgery can be carried out to remove foreign objects or close injured eye bags, coupled with giving antibiotic drugs into the eye sphere and tetanus immunization. In cases of endogenous infection, endoftalmitis can be treated with extensive spectral antibiotic fluids that are inserted directly into the eye. In the case of fungal infection, antijamur can be given by drinking, injected through infusion, or directly into the eye ball.

The rate of endoftalmitis healing generally depends on the causes of the germs, how severe the decline in the sharpness of the vision when diagnosed, and how fast initial therapy is given. In general, endoftalmitis endogenous has a lower cure rate than exogenous endoftalmitis. This happens because in endogenous endophtalmitis, the agent that causes is a more virulent bacteria or fungi plus an immune condition that is usually lower due to diabetes, HIV/AIDS, or the use of long-term immune-reducing drugs.

The lower the sharpness of vision at the time of diagnosis, the lower the sharpness of the expected vision when recovering. The sooner the therapy is given, the higher the cure rate, and vice versa, if the therapy is delayed due to delays in diagnosis, the more severe the complications will be.

Complications

Endoftalmitis that is not handled properly can cause various complications, including residential vision disorders, blindness, eyeball damage, so it is necessary to enucleate, namely removing the eyepiece by leaving muscles and tissue around the eye ball. 

Prevention

Endoftalmitis prevention can be done by avoiding risk factors, for example:

• Prevention of diabetes by regulating eating patterns, exercising regularly, and maintaining ideal weight
• If you already have diabetes, control blood sugar by taking regular medication while monitoring blood sugar
• Prevention of HIV/AIDS by not changing sexual partners and avoiding the use of illegal drugs
• If you have been diagnosed with HIV/AIDS, you need to take antiviral medication regularly according to your doctor's prescription
• If your job risks describing foreign objects into the eye. (such as irons, farmers, or working in a chemical factory), always use eye protection at work

When Do You Have To Go To A Doctor?

If you experience symptoms like:

• Red eyes accompanied by decreased vision
• Eye pain
• Pubbles of swollen eyes
• The liquid looks like pus coming out of the eye
• Has a catatric surgery history
• Exposed to foreign objects in the eye ball

Immediately go to the nearest emergency room. General practitioners will refer you to an eye specialist for follow-up examinations and management. Endoftalmitis diagnosis needs to be done quickly so that it can be handled before complications occur.

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