ISSN 2398-2969      

Endophthalmitis/Panophthalmitis

icanis
Contributor(s):

Rhea Morgan


Introduction

  • Endophthalmitis is inflammation of the internal structures of the eye, namely the uvea, retina, vitreous, and sometimes the lens.
  • Panophthalmitis is purulent inflammation of all parts of the eye, and often arises when endophthalmitis extends into the cornea and sclera.
  • Cause:bacteria, mycoses, protothecosis Protothecosis , leishmaniasis Canine leishmaniosis , foreign bodies, neoplasia.
  • Signs:panuveitis, blindness, secondary glaucoma, possible distortion of the shape or size of the eye.
  • Diagnosis:clinical examination, bacterial culture, histopathology.
  • Treatment:topical and systemic antibiotic or antifungal agents.
  • Prognosis:Endophthalmitis: poor for saving vision, fair for saving the globe. Panophthalmitis: guarded, usually requires enucleation.

Pathogenesis

Etiology

  • Endophthalmitis/panophthalmitis falls into roughly three etiologic categories:
    • Inflammation associated with an underlying systemic illness, ie the systemic mycoses, protothecosis, leishmaniasis, neoplasia, and bacterial septicemia (rare). Any infectious cause of chorioretinitis Chorioretinitis can potentially result in endophthalmitis, but the diseases listed are the most common causes.
    • Inflammation associated with a bacterial infection that is introduced into the eye, eg following cataract surgery, following penetrating ulcers, or associated with contamination of penetrating wounds.
    • Inflammation associated with migration of penetrating foreign bodies Eye: ocular foreign body. This last category may or may not be complicated by bacterial infection.

Predisposing factors

General
  • Exposure to pathogenic or drug resistant bacteria.
  • Pre-existing inflammation within the eye or penetration of the eye.

Pathophysiology

  • Endophthalmitis may begin as penetrating keratitis, anterior uveitis or chorioretinitis. Progressive infection and necrosis, or migration/inflammation induced by a foreign body results in extension of the inflammation into the surrounding or adjacent structures.
  • Panophthalmitis results when the sclera also becomes involved. Panophthalmitis may then extend into the periocular tissues and affect the episclera, conjunctiva, extraocular muscles, periorbital fat, third eyelid and external eyelids.
  • Endophthalmitis does not usually result in a change in the shape of the eye, although the development of severe secondary glaucoma may cause buphthalmos.
  • Panophthalmitis may cause dramatic thickening of the sclera and periocular tissues, along with secondary glaucoma, and may cause a change in the shape of the eye.
  • Vision is threatened with both conditions, and blindness is almost always present in eyes with panophthalmitis.
  • Extension of inflammation into the optic nerve may also occur.

Timecourse

  • Most cases of endophthalmitis/panophthalmitis develop rapidly. Clinical signs may develop within 24-72 hours.
  • Clinical course is often protracted, with therapy required for several weeks to months.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Cullen C L, Caswell J L, Grahn B H (2000) Intravascular lymphoma presenting as bilateral panophthalmitis and retinal detachment in a dogJ Am Anim Hosp Assoc 36, 337-342 PubMed.
  • Ciaramella P, Oliva G, Luna R D et al (1997) A retrospective clinical study of canine leishmaniasis in 150 dogs naturally infected with Leishmania infantumVet Rec 141 (21), 539-543 PubMed.
  • Wolfer J, Grahn B, Kerr D (1996) Diagnostic ophthalmology.​ Case report of anterior uveitis and endophthalmitisCan Vet J 37 (8), 506-507 PubMed.
  • Taylor M M, Kern T J, Riis R C et al (1995) Intraocular bacterial contamination during cataract surgery in dogsJ Am Vet Med Assoc 206 (11), 1716-1720 PubMed.

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