Post-traumatic endophthalmitis: Difference between revisions
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==Overview== | ==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.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid15522366">{{cite journal| author=Essex RW, Yi Q, Charles PG, Allen PJ| title=Post-traumatic endophthalmitis. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 11 | pages= 2015-22 | pmid=15522366 | doi=10.1016/j.ophtha.2003.09.041 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522366 }} </ref> | |||
==Historical Perspective== | ==Historical Perspective== | ||
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==Pathophysiology== | ==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.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid15522366">{{cite journal| author=Essex RW, Yi Q, Charles PG, Allen PJ| title=Post-traumatic endophthalmitis. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 11 | pages= 2015-22 | pmid=15522366 | doi=10.1016/j.ophtha.2003.09.041 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522366 }} </ref> | |||
==Causes== | ==Causes== | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The incidence of traumatic endophthalmitis may be decreasing due to earlier wound closure and prompt initiation of antibiotics. | |||
===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.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid15522366">{{cite journal| author=Essex RW, Yi Q, Charles PG, Allen PJ| title=Post-traumatic endophthalmitis. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 11 | pages= 2015-22 | pmid=15522366 | doi=10.1016/j.ophtha.2003.09.041 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522366 }} </ref> | |||
*The [[incidence]] of post-traumatic endophthalmitis was estimated to range from 1,300 to 61,000 per 100,000 individuals with intraocular foreign body.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid15522366">{{cite journal| author=Essex RW, Yi Q, Charles PG, Allen PJ| title=Post-traumatic endophthalmitis. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 11 | pages= 2015-22 | pmid=15522366 | doi=10.1016/j.ophtha.2003.09.041 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522366 }} </ref> | |||
==Risk Factors== | ==Risk Factors== | ||
Common risk factors in the development of post-traumatic bacterial endophthalmitis include:<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid15522366">{{cite journal| author=Essex RW, Yi Q, Charles PG, Allen PJ| title=Post-traumatic endophthalmitis. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 11 | pages= 2015-22 | pmid=15522366 | doi=10.1016/j.ophtha.2003.09.041 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15522366 }} </ref> | |||
*Retained intraocular foreign bodies | |||
*Delay in repair more than 24 hours | |||
*Disruption of the lens | |||
==Screening== | ==Screening== | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===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=== | ===Complications=== | ||
===Prognosis=== | ===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.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid3495766">{{cite journal| author=Affeldt JC, Flynn HW, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD| title=Microbial endophthalmitis resulting from ocular trauma. | journal=Ophthalmology | year= 1987 | volume= 94 | issue= 4 | pages= 407-13 | pmid=3495766 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3495766 }} </ref> | |||
==Diagnosis== | ==Diagnosis== | ||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
===History and Symptoms=== | ===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=== | ===Physical Examination=== | ||
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====CT==== | ====CT==== | ||
=====Post-traumatic endophthalmitis===== | |||
Orbital CT scan is helpful for localization of metallic intra ocular foreign bodies (IOFBs) in the setting of trauma. <ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid3495766">{{cite journal| author=Affeldt JC, Flynn HW, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD| title=Microbial endophthalmitis resulting from ocular trauma. | journal=Ophthalmology | year= 1987 | volume= 94 | issue= 4 | pages= 407-13 | pmid=3495766 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3495766 }} </ref> | |||
====MRI==== | ====MRI==== | ||
=====Post-traumatic endophthalmitis===== | |||
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.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid3495766">{{cite journal| author=Affeldt JC, Flynn HW, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD| title=Microbial endophthalmitis resulting from ocular trauma. | journal=Ophthalmology | year= 1987 | volume= 94 | issue= 4 | pages= 407-13 | pmid=3495766 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3495766 }} </ref> | |||
====Ultrasound==== | ====Ultrasound==== | ||
On ocular ultrasonography, endophthalmitis may characterized by anterior vitreous [[haze echoes]] and retinochoroidal thickening.<ref name="pmid23438028">{{cite journal| author=Durand ML| title=Endophthalmitis. | journal=Clin Microbiol Infect | year= 2013 | volume= 19 | issue= 3 | pages= 227-34 | pmid=23438028 | doi=10.1111/1469-0691.12118 | pmc=3638360 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23438028 }} </ref><ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref> | |||
====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-operative or post-surgical endophthalmitis.<ref name="pmid20390032">{{cite journal| author=Kernt M, Kampik A| title=Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. | journal=Clin Ophthalmol | year= 2010 | volume= 4 | issue= | pages= 121-35 | pmid=20390032 | doi= | pmc=2850824 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20390032 }} </ref><ref name="pmid3495766">{{cite journal| author=Affeldt JC, Flynn HW, Forster RK, Mandelbaum S, Clarkson JG, Jarus GD| title=Microbial endophthalmitis resulting from ocular trauma. | journal=Ophthalmology | year= 1987 | volume= 94 | issue= 4 | pages= 407-13 | pmid=3495766 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3495766 }} </ref> | |||
====Other Imaging Findings==== | ====Other Imaging Findings==== |
Revision as of 12:57, 4 August 2016
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
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.
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]
Risk Factors
Common risk factors in the development of post-traumatic bacterial endophthalmitis include:[1][2]
- Retained intraocular foreign bodies
- 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][3]
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
CT
Post-traumatic endophthalmitis
Orbital CT scan is helpful for localization of metallic intra ocular foreign bodies (IOFBs) in the setting of trauma. [1][3]
MRI
Post-traumatic endophthalmitis
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][3]
Ultrasound
On ocular ultrasonography, endophthalmitis may characterized by anterior vitreous haze echoes and retinochoroidal thickening.[4][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-operative or post-surgical endophthalmitis.[1][3]
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 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 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 3.2 3.3 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.
- ↑ Durand ML (2013). "Endophthalmitis". Clin Microbiol Infect. 19 (3): 227–34. doi:10.1111/1469-0691.12118. PMC 3638360. PMID 23438028.