Endophthalmitis : An Update

Endophthalmitis is inflammation of the intraocular cavities consequent to introduction of microbes. In the absence of aggressive intervention, this often results in poor visual outcome due to irreversible damage to the retinal photoreceptor cells. Endophthalmitis is usually the sequel of intraocular surgery (Postoperative endophthalmitis), trauma (Posttraumatic endophthalmitis) or systemic infection (Endogenous endophthalmitis) or spread from adjacent periocular tissues. The presentation could be fulminant, acute or chronic. Special situations such as endophthalmitis after intravitreal injections and bleb related are a special cause of concern. The majority of cases are due to bacterial infection, although fungal infections also occur. Endophthalmitis is characterised by a massive infiltration of the vitreous by inflammatory cells, especially neutrophils that clinically manifests as vitritis. Progression of inflammation beyond this stage leads to hypopyon and a painful eye, which if not treated leads to blinding sequelae such as corneal perforation, orbital cellulitis, panophthalmitis and phthisis. Early diagnosis and prompt cum aggressive treatment are crucial to save vision. Improvements in surgical techniques, standardization of operating protocols with emphasis on hygienic standards, emergence of powerful antimicrobial drugs, early vitrectomy have lead to a decreased incidence of and better prognosis in endophthalmitis. This review focuses on current principles, techniques, newer types of endophthalmitis and novel antimicrobial drugs, recent experimental and clinical efforts in prophylaxis and management of endophthalmitis.