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Red Eyes after Cataract Surgery and Other Operations
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Examination: Visual acuity must be checked and documented at each post-operative review. On the slit-lamp, examine the patient for any risk factors of ocular surface disease such as blepharitis, mucocoele, entropion or ectropion. Lid swelling and inflammation are also signs associated with endophthalmitis. Is there any yellow discharge from the eye? Perform a conjunctival swab of any discharge prior to examining the ocular surface specifically looking at wound and injection sites. If the patient complains of discomfort with blinking or eye movement this is more likely to be due to an ocular surface problem. Use fluorescein 2% to check for a wound leak from corneal incisions, sutures, trabeculectomy and vitrectomy port sites. In post-filtration surgery in glaucoma cases, look for any signs of pus-discharge, a milky bleb and wound leak suggestive of blebitis. In post-corneal graft patients, look for loose sutures that may be a source of irritation or infection and signs of graft failure or rejection. Look for signs of recurrent corneal disease in those with previous herpetic disease.
Lens and cataracts
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Endophthalmitis is the inflammation of the vitreous and aqueous humour, usually caused by infection. It is characterized by progressive vitritis. The main measure of prevention is the use of povidone-iodine 5% antiseptic to clean the patient's eyes preoperatively.
Management of endophthalmitis
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Mandi D Conway, Gholam A Peyman
Patient symptoms indicative of endophthalmitis include ocular pain, diminished vision, and headache, with associated drowsiness. Although pain is an important symptom, it is not universal;49 nearly 25% of patients in the Endophthalmitis Vitrectomy Study (EVS) reported no pain (and slightly more than 30% also had negative cultures).50
Hypervirulent Klebsiella Pneumoniae, an Emerging Cause of Endogenous Endophthalmitis in A French Center: A Comparative Cohort Study
Published in Ocular Immunology and Inflammation, 2023
Jean-Philippe Martellosio, Nabil Gastli, Rebecca Farhat, Asmaa Tazi, Pierre Duraffour, Benjamin Rossi, Etienne Canouï, Caroline Morbieu, Annick Billoët, Luc Mouthon, Claire Poyart, Antoine Brézin, Paul Legendre
Endophthalmitis is a devastating eye infection involving the vitreous and/or aqueous humor, and can lead to blindness.1 Most cases are exogenous and only 5–15% are classified as endogenous, caused by transient bacteremia or fungemia.1 A worldwide systematic review of bacterial EE between 1986 and 2012 has reported Klebsiella pneumoniae (KP) as the major causative organism (27%, 93/342 cases), including mainly (78%) cases originated from East Asia.2 Indeed, K. pneumoniae may reach up to 61% of documented EE cases in Asia.3 Conversely, fungi and Gram-positive bacteria are more commonly reported in Europe and North America.1,2 In Europe, according to the same worldwide systematic review of bacterial EE, Staphylococcus aureus, Streptococcus pneumoniae, and Neisseria meningitidis are the leading bacteria causing EE.2
Retinal Vasculitis and Posterior Pole Preretinal Exudates in Exogenous Bacterial Endophthalmitis: Management and Visual Outcomes
Published in Ocular Immunology and Inflammation, 2022
Kuan-Jen Chen, Yen-Po Chen, Nan-Kai Wang, Ming-Hui Sun, Chi-Chin Sun, Wei-Chi Wu, Chi-Chun Lai
Endophthalmitis is a serious intraocular inflammatory disorder resulting from infection of the vitreous cavity, often resulting in severe vision loss. Retinal vasculitis is one of the early signs of exogenous endophthalmitis.1–3 Recently, postoperative hemorrhagic occlusive retinal vasculitis has been reported in patients receiving intracameral antibiotics, such as vancomycin.4–7 Although the precise cause remains unknown, this disease may represent a delayed immune reaction similar to vancomycin-induced leukocytoclastic vasculitis.6 Inferior or posterior pole preretinal exudates are often present in an eye with severe endophthalmitis. Preretinal exudates consist largely of tissue debris, inflammation by-products, and recruited leukocytes. Posterior pole preretinal exudates with retinal vasculitis have been reported in uveitis and infectious endophthalmitis.1–3 However, these signs are difficultly recognized preoperatively and typically observed intraoperatively.
Endogenous endophthalmitis due to methicillin-resistant Staphylococcus aureus bacteremia in a patient with COVID-19
Published in Baylor University Medical Center Proceedings, 2022
Tim Brotherton, Eugene Nwankwo, Debapria Das, Adam Fritz
Endophthalmitis is a rare infection of the interior eye by bacteria or fungi. These infections are usually exogenous in nature and are caused as a complication of ophthalmic procedures or penetrating ocular trauma. The most commonly implicated pathogens are gram-positive coagulase-negative organisms, especially Staphylococcus epidermidis.1 In 2% to 8% of cases, endogenous endophthalmitis results from hematogenous seeding of the eye by a bacterial or fungal source.2,3 Presenting symptoms include vision loss and eye pain; the exam often shows a hypopyon, and fundoscopy shows vitritis. In this case, we discuss a man who presented with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and COVID-19 pneumonia who ultimately developed bacterial endophthalmitis following corticosteroid treatment.