Traumatic Endophthalmitis
Endophthalmitis, one of the devastating complications of penetrating ocular trauma, differs in many respects from the other classes of endophthalmitis. Among patients with infectious endophthalmitis, posttraumatic endophthalmitis comprises approximately 2
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Traumatic Endophthalmitis Tapas R. Padhi
Endophthalmitis following penetrating ocular trauma differs in many respects from other classes of endophthalmitis. Among patients with infectious endophthalmitis, posttraumatic endophthalmitis comprises approximately 25–30% of cases [1–4]. This is about ten times higher than postoperative endophthalmitis [5]. Risk factors of endophthalmitis following penetrating trauma include presence of an intraocular foreign body (IOFB) [1], lens rupture, delayed primary wound closure (>24 h), trauma or IOFB in a rural setting [1, 2, 6], trauma with contaminated objects and food stuffs [6, 7], and injuries by nails of pets and wild animals [1, 8]. Reports from India show that majority of traumatic endophthalmitis is seen in children and adolescence; injuries with bow-arrow, broom stick, and hypodermic needle are few of the peculiar mode of injury leading to traumatic endophthalmitis in this subcontinent [8–11]. Improperly disposed hypodermic syringes with needles are frequently used as toys by children to squirt water at each other with accidental globe penetration and endophthalmitis [12]. Hyphema and iris prolapse have been claimed to have some protective effect against endophthalmitis [13]. While hyphema is said to unlock the blood ocular barrier and release factors inhibiting bacterial growth, a prolapsed iris tissue could directly block the entrance of organisms inside the eye. Lacerations of length less than 2 mm have low chance of uveal prolapse (consequently no sealing of the wound by uveal tissue) and hence a higher risk of endophthalmitis than larger wounds [13].
T.R. Padhi LV Prasad Eye Institute, Bhubaneswar, India e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2018 T. Das (ed.), Endophthalmitis, https://doi.org/10.1007/978-981-10-5260-6_9
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T.R. Padhi
Etiology A wide range of microbes that enter the eye following ocular trauma can cause infective endophthalmitis. The microorganisms are either derived from the normal periocular flora that gain entry after a delay in primary wound closure or carried into the wound by contaminated injury-causing objects. A variety of microbes have been implicated in the posttraumatic endophthalmitis including gram-positive cocci (most common), Bacillus species, fungi, and mixed infections [14, 15]. Although Staphylococcus epidermidis is the most common organism, as in postoperative acute endophthalmitis, other microorganisms are more frequently represented and the multi-microbial involvement is common. There is a high incidence of Bacillus species endophthalmitis following open-globe injuries, particularly in the setting of soil contamination. Bacillus cereus infection is associated with 2–7% of all penetrating wound to the eye [16]. The causative agents and their relative proportion vary depending on the geographical location, type of injury, living environment, and time from injury to wound repair. Posttraumatic endophthalmitis caused by a fungus is less common (range from 0% to 15.4%) than bacterial cases and are
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