Endophthalmitis

ENDOTOXINS, see Toxins. ENDOPHTHALMITIS (endophthalmitis), according to Fuchs, is an inflammation of the iris and ciliary body, iridocyclitis, or more rarely iridochoroiditis, occurring after penetrating wounds of the eye (primary endophthalmitis) or upon the penetration of infection through a corneal fistula, cystic scars, and scars fused with the iris (secondary endophthalmitis). Depending on the type and strength of the infection, as well as the defensive forces of the organism itself, endophthalmitis can manifest in various clinical forms, from sluggishly progressing chronic iridocyclitis to panophthalmitis. The onset of primary endophthalmitis is usually obscured by the symptoms of irritation that accompany any serious eye wound, and only the subsequent course allows for an accurate diagnosis, unless, of course, the endophthalmitis proceeds from the very beginning with the violent picture of panophthalmitis. When diagnosing endophthalmitis, it is taken into account that the symptoms of inflammation do not subside gradually within the first 2-3 weeks but persist to the same degree or intensify; that the pupil does not dilate with atropine; that persistent opacities form in the form of a film in the area of the pupil; that the number of adhesions of the pupil margin to the lens capsule increases, or even a complete flat adhesion of the posterior surface of the iris to the lens forms; that exudation in the inflamed tissues does not decrease but, on the contrary, organizes into connective tissue films (synechiae), especially behind the lens; that tenderness appears upon touching the area of the ciliary body; and that intraocular pressure gradually decreases and the light perception of the eye becomes irregular. From the point of view of pathological anatomy, the various forms of endophthalmitis are essentially the same and differ from each other only quantitatively. As a rule, in endophthalmitis, there is a picture of exudative inflammation with the localization of the infection inside the eye. Fibrinous-cellular exudate is usually localized in the vitreous body, retina, and optic nerve. In the latter, the exudate is usually located only in their inner layers and on their surface. In severe cases, the retina may partially or completely melt in the exudate, and the inflammatory process may also involve the inner layers of the choroid. In such cases, the non-pigmented epithelium of the ciliary body is completely lost among the cellular exudate; the pigment epithelium also suffers. Among the infiltrating cells, leukocytes predominate, but in sluggish chronic cases, lymphocytes may also be in the foreground. In their pathological-anatomical essence, endophthalmitis differs from so-called sympathetic iridocyclitis, in which there is a picture of proliferative inflammation, localized mainly in the outer layers of the vascular tunic, and in which, conversely, the retina, optic nerve, and vitreous body suffer only secondarily and to a minor degree. The prognosis for endophthalmitis is doubtful in all cases, and in severe ones, it is particularly unfavorable. In the fight against endophthalmitis, measures for the prevention of eye injuries in production and daily life must take first place. In the treatment of wounds, to prevent secondary infection, it is necessary to remove tissues that have prolapsed from the wound, perform conjunctival plastic surgery according to Kuhnt for gaping wounds, and provide general treatment in the form of injections of collargol and electrargol into the blood, serum therapy, oral administration of urotropine, and sometimes mercury inunctions. To combat infection at the site of the wound, disinfecting substances are used, such as 3% hydrogen peroxide, subconjunctival injections of mercuric chloride and mercury cyanide; for limited suppuration, cauterization with a thermo- or galvanocautery is used. Symptomatic treatment of iridocyclitis follows general rules. If there is a suspicion of the possibility of sympathetic inflammation of the other eye, enucleation is performed (see also Iris, Uveitis).

D. Pokrovsky.