Recommandé
Contenu connexe
Tendances
Tendances (20)
Similaire à Endophthalmitis
Plus de Raafi Ul Zargar
Dernier
Dernier (20)
Endophthalmitis
- 1. END PHTHALMITIS R A A F I U L B A S H E E R
- 2. Table of Contents • DEFINITION • ETIOLOGY • CLINICAL FEATURES • TREATMENT 2
- 3. 1. DEFINITION • INFLAMMATION OF INNER STRUCTURES OF EYEBALL i.e. UVEALTISSUE & RETINA ASSOCIATED WITH POURING OF EXUDATE INVITREOUS CAVITY, ANTERIOR CHAMBER & POSTERIOR CHAMBER
- 5. A. INFECTIVE ENDOPHTHALMITIS • PERFORATIING INJURIES • PERFORATION OF INFECTED CORNEAL ULCER • POSTOPERATIVE INFECTIONS FOLLOWING INTRAOCULAR OPERATIONS EXOGENOUS INFECTION • VERY RARE • ORBITAL CELLULITIS • THROMBOPHLEBITIS • INFECTED CORNEAL ULCER SECONDARY INFECTIONS • METASTATIC ENDOPHTHALMITIS • MAY OCCUR RARELY THROUGH BLOODSTREAM • CARIES TEETH • GENERALISED SEPTICAEMIA • PUERPERAL SEPSIS ENDOGENOUS ENDOPHTHALMITIS MODE OF INFECTION
- 6. A. INFECTIVE ENDOPHTHALMITIS • M.C.-GRAM POSITIVE COCCI • Staphylococcus epidermidis • Staphylococcus aureus • OTHERS • Streptococci • Pseudomonas • Pneumococcus • Corynebacterium • Propionibacterium acnes • Actinomycetes BACTERIAL ENDOPHTHALMITIS • RARE • CAUSATIVE ORGANISMS • Aspergillus • Fusarium • Candida ,etc. FUNGAL ENDOPHTHALMITIS CAUSATIVE AGENTS
- 7. 1 2 4 3 B. NON-INFECTIVE (STERILE) ENDOPHTHALMITIS POST OPERATIVE STERILE ENDOPHTHALMITIS INTRAOCULAR TUMOUR NECROSIS POST-TRAUMATIC STERILE ENDOPHTHALMITIS PHACOANAPHYLACTIC ENDOPHTHALMITIS • INFLAMMATIONOF INNER STRUCTURESOF EYEBALL CAUSED BY CERTAIN TOXINS/TOXIC SUBSTANCES
- 8. 1 2 4 3 1.POST OPERATIVE STERILE ENDOPHTHALMITIS POST OPERATIVE STERILE ENDOPHTHALM ITIS • CHEMICALS ADHERENT TO INTRAOCULAR LENS • CHEMICALS ADHERENT TO INSTRUMENTS • TOXIC ANTERIOR SEGMENT SYNDROME (SEVERE REACTION MAINLY CONFINED IN ANTERIOR SEGMENT) MAY OCCUR AS TOXIC REACTION TO:
- 9. 4 3 1 2 2. POST-TRAUMATIC STERILE ENDOPHTHALMITIS • RETAINED INTRAOCULAT FOREIGN BODY • PURE COPPER MAY OCCUR AS TOXIC REACTION TO: POST- TRAUMATIC STERILE ENDOPHTHAL MITIS
- 10. 2 3 1 4 3. INTRAOCULAR TUMOUR NECROSIS • STERILE ENDOPHTHALMITIS • MASQUERADE SYNDROME MAY PRESENT AS: INTRAOCULAR TUMOUR NECROSIS
- 11. 2 4 1 3 4. PHACOANAPHYLACTIC ENDOPHTHALMITIS • LENS PROTEINS IN PATIENTS WITH MORGAGNIAN CATRACT MAYBE INDUCED BY: PHACOANAP HYLACTIC ENDOPHTHAL MITIS
- 12. 3. CLINICAL FEATURES • ACUTE POSTOPERATIVE ENDOPHTHALMITIS IS CATASTROPIC COMPLICATION OF INTRAOCULAR SURGERY
- 13. SOURCE OF INFECTION 01 02 03 04 05FLORA OF EYELIDS FLORA OF CONJUCTIVA FLORA OF LACRIMAL SAC CONTAMINATED SOL’S & INSTRUMENTS ENVIRONMENTAL FLORA
- 14. ONSET • USUALLY OCCURS 1-7 DAYS AFTER OPERATION ACUTE
- 15. ONSET • OCCURSAWEEKTO MONTH AFTER SURGERY • M.C.C-FUNGI • 2nd M.C.C- Propionibacterium acne DELAYED ONSET
- 16. 1 SYMPTOMS 1 2 3 4 5 SEVERE OCCULAR PAIN REDNESS LACRIMATION PHOTOPHOBIA LOSS OF VISION
- 17. SIGNS LIDS 0 1• RED AND SWOLLEN CONJUCTIVA 0 2• CHEMOSIS • MARKED CIRCUMCORNEAL CONGESTION CORNEA 0 3• ODEMATOUS • CLOUDY • RING INFILTRATION MAYBE FORMED EDGES OF WOUND 0 4• YELLOW & NECROTIC • WOUND MAY GAPE IN EXOGENOUS FORM ANTERIORCHAMBER 0 5• HYPOPYON • SOON IT BECOMES FULL OF PUS IRIS 0 6• WHEN VISIBLE BECOMES ODEMATOUS & MUDDY SEVERE POSTOPERATIVE ENDOPHTHALMITIS WITHWOUND GAPE
- 18. SIGNS PUPIL 07 • SHOWS YELLOW REFLEX DUE TO PURULENT EXUDATION INVITREOUS • WHEN ANTERIOR CHAMBER BECOMES FULL OF PUS, IRIS & PUPIL DETAILS NOT SEEN VITREOUS EXUDATION 08 • SEEN IN METASTATIC FORM & IN DEEP INFECTIONS • YELLOWSH WHITE MASS SEEN THROUGH FIXED DILATED PUPIL – SIGN- AMAUROTIC CAT’S-EYE REFLEX IOP 09 • RAISED IN EARLY STAGES • SEVERECASES-CILIARY PROCESS DESTROYED • FALL IN IOP MAY ULTIMATELY RESULT IN SHRINKAGE OF GLOBE POST OPERATIVEACUTE ENDOPHTHALMITIS
- 19. 4. TREATMENT EARLY DIAGNOSIS &VIGROUS THERAPY IS HALLMARK OF TREATMENT OF ENDOPHTHALMITIS
- 20. 1. ANTIBIOTICTHERAPY • TRANSCONJUCTIVALLYUNDERTOPICAL ANESTHETIC FROMAREA OF PARS PLANA ROUTE • 1ST CHOICE • VANCOMYCIN 1mg in 0.1ml + CEFTAZIDIME 2.25mg in 0.1ml • 2ND CHOICE • VANCOMYCIN 1mg in 0.1ml +AMIKACIN 0.4mg in 0.1ml DRUGS
- 21. START IMMEDIATELY USED FREQUENTLY (EVERY 30 MIN.TO 1 HR. INFO VANCOMYCIN OR CEFAZOLINE + AMIKACIN OR TOBRAMYCIN DRUGS
- 22. LIMITED ROLE INFO • CIPROFLOXACIN I.V. 200mg BD FOR 3-4 DAYS FOLLOWED BY ORALLY 500mg BD FOR 6-7 DAYS (OR) • VANCOMYCIN 1gm I.V. BD + CEFTAZIDINE 2gm I.V. 8 HOURLY • CEFAZOLIN 1.5gm I.V. 6 HOURLY + AMIKACIN 1gm I.V. 3X/DAY DRUGS
- 23. 2. STEROID THERAPY • INTRAVITREAL INJ.-DEXAMETHASONE + ANTIBIOTICS • TOPICAL- DEXAMETHASONE(0.1%) OR PREDACETATE(1%) • SYSTEMIC STEROIDS • ORAL DEXAMETHASONE ROUTE & DRUGS
- 24. 3. SUPPORTIVE THERAPY • CYCLOPLEGICS- 1% ATROPINE OR 2% HOMATROPINE EYEDROPS • ANTIGLAUCOMA DRUGS- ORAL ACETAZOLAMIDE OR TIMOLOL • LANSOPRAZOLE 30mg OD • GIVEN BEFORE STEROIDS • GASTRIC PROTECTION ROUTE & DRUGS
- 25. 4. VITRECTOMY • NO IMPROVEMENT AFTER INTENSIVE THERAPY OF 48 – 72 HRS • SEVERE INFECTION • VISUAL ACUITY REDUCED TO HAND MOVEMENT CLOSE TO FACE INDICATIONS • REMOVES • INFECTING ORGANISMS • TOXINS • ENZYMES ROLE
- 26. T H A N K Y O U !