Tag Archives: infection

Infectious Endophthalmitis

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is endophthalmitis?

Endophthalmitis (“end-off-thal-my-tis”) is a severe inflammation inside the eye. The inflammation may be due to an infection or it may be “sterile.” Endophthalmitis threatens profound loss of vision and possible loss of the eye. Bacterial endophthalmitis usually requires urgent treatment to save the eye.

What causes endophthalmitis?

Endophthalmitis may be caused by an auto-immune reaction (the body attacks itself), it may be due to a foreign substance introduced into the eye in an accident or surgery, or it may be due to an infection. Here we will discuss endophthalmitis due to infection.

Infections may be caused by a number of viruses, fungi, parasites, and bacteria. Infectious endophthalmitis is classified as endogenous and exogenous. Endogenous endophthalmitis occurs when an infection enters the eye from inside the body, usually through the blood stream. Exogenous endophthalmitis occurs when an infection enters the eye from outside the body, usually from an opening into the eye from trauma, surgery, or intraocular injections.

Although the risk of endophthalmitis is low for a single surgery, the risk increases over time with multiple Intraocular injections. For example, after 5-6 years of injections for macular degeneration, the risk rises to about one in 200.

How is infectious endophthalmitis diagnosed?

Infectious endophthalmitis is suspected when severe inflammation is found inside the eye on an exam. It is usually accompanied by pain and loss of vision. Diagnosis is confirmed with a culture of the fluid inside the eye taken in the office or the operating room.

 How is infectious endophthalmitis treated?

Infectious endophthalmitis is treated with antibiotic injections into the eye performed in the office or in the operating room. In severe cases, vitrectomy surgery is needed to remove some of the infected material. Vitrectomy is performed in the hospital operating room as a major eye surgery involving small incisions into the eye. Eye drops  (steroid and non-steroid) are used frequently to help treat infection and to decrease the inflammation that can damage the eye. Sometimes additional steroid medications are used. The recovery of vision is very slow, taking weeks to months. If permanent damage occurs as a result of endophthalmitis, little or no recovery of vision may be possible. Frequent visits to the doctor are necessary at first to give the best results.

If you have questions, please do not hesitate to ask your doctor. Please visit www.retinavitreous.com

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2018-2023 Designs Unlimited of Florida.  All Rights Reserved.

The Ocular Histoplasmosis Syndrome

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is the ocular histoplasmosis syndrome (OHS)?

OHS is a condition where abnormal blood vessels may grow under the retina causing blurred, distorted vision. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” of objects you look at and sends the image to the brain.

What causes the ocular histoplasmosis syndrome?

Most cases of OHS occur as a result of an infection by the fungus Histoplasma capsulatum. This organism is found in bird and bat dropping and is most common in the Ohio and Mississippi river valley areas. High-risk activities include farmers, pest control workers, poultry keepers, construction workers, roofers, landscapers, and cave explorers. When soil is disturbed by wind or human activity, the fungal spores become airborne. After the spores are inhaled, they may cause a brief “flu-like” infection or may cause no symptoms at all in a healthy individual. In infants, the elderly, and those with compromised immune systems severe complications may include acute respiratory distress syndrome (ARDS), pericarditis, adrenal insufficiency, and meningitis.

Usually there are no visual symptoms at the time of active infection. However, after the infection is gone, scars are left in the body. These scars may be seen on x-rays of the lung, liver, and other parts of the body. Many years after the initial active infection, scars under the retina may cause loss of vision from the growth of abnormal blood vessels. At this stage, there is no active infection and a person with OHS cannot transmit an infection to someone else. The risk of loss of vision from OHS appears greater in those who smoke tobacco.

What are the symptoms of the ocular histoplasmosis syndrome?

Decreased central vision is common. It may be most notable at near and is usually associated with distortion, which means straight lines appear wavy or crooked. These symptoms come from active leakage of fluid and blood under the retina from abnormal blood vessels associated with OHS scars. Without treatment more scare tissue forms under the retina and a permanent blind spot develops in the center of vision.

What treatment is available?

There are a number of treatments for OHS and it is important to start treatment as soon as possible after the start of symptoms. The main treatment for the abnormal leaking blood vessels involves medication injection in the office. Medicine injections may be given painlessly in the office with anesthetics. Repeat injections may be required if leakage from the abnormal blood vessels returns. Most people respond well with an improvement in vision. The eye should be monitored because new areas of leakage may occur at a future date. An Amsler grid chart should be used at home on a regular basis to detect recurrent activity at a future date.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2017-2022 Designs Unlimited of Florida. All Rights Reserved

Ocular Toxoplasmosis

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is ocular toxoplasmosis?

Ocular toxoplasmosis is an inflammation of the eye caused by an infection of the retina by a parasite called Toxoplasma gondii. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” of objects you look at and sends the image to the brain.

What causes ocular toxoplasmosis?

Toxoplasma gondii infects humans and animals throughout the world. Twenty to fifty percent of adults in the United States test positive for exposure, but few people experience symptoms. The most common presentation resembles mononucleosis with symptoms of fever, fatigue, and swollen lymph glands. Because the toxoplasma organism can become inactive and form a protective microscopic cyst within human cells, it can cause relapses of infection and spread to new areas of the body months to years after the initial infection. If the parasite spreads through the blood stream to the eye, ocular toxoplasmosis may threaten blindness.

How is toxoplasmosis contracted?

The most common ways to contract infection are as follows: 1.) Hand-to-mouth transmission of the toxoplasma organism in cat feces e.g. cleaning the litter box. 2.) Eating undercooked meat, chicken, or eggs from infected animals. 3.) Eating unwashed fruits and vegetables that are contaminated by animal feces. 4.) Hand-to-mouth transmission from handling infected raw meat or animal products. 5.) Transmission from infected mother to child through the placenta during pregnancy. 6.) Rarely, Toxoplasma infection may acquired through contaminated drinking water or dust in the air.

Toxoplasma gondii completes its life cycle by producing millions of oocysts (eggs) in the intestines of the cat. These infectious eggs leave the cat in the feces and may lie dormant in the ground for up to two years. These eggs may infect an animal that may eat from the ground or a human who eats unwashed, contaminated fruits and vegetables from the ground. Once inside a human or animal, the eggs “hatch”, multiply, and spread throughout the body. When the immune system attacks the parasite, it becomes dormant and “hibernates” inside cells throughout the body. In months or years in the future, it may become active to cause infection again.

What are the symptoms of ocular toxoplasmosis?

If toxoplasma reaches the eye, early symptoms include seeing new tiny floating spots (floaters), pain, redness, tearing, light sensitivity, and blurred vision. Late symptoms include permanent blind spots in the vision and, rarely, blindness. These symptoms are not specific for ocular toxoplasmosis, but they are especially important to recognize in people with known toxoplasma scars in the retina. If such symptoms are promptly reported to the doctor, treatment may minimize permanent damage to the eye.

What treatment is available?

Sulfa antibiotics (Septra or Bactrim) are frequently used for several weeks to treat active infection. In some cases of toxoplasmosis, another antibiotic called clindamycin is used. This medicine may rarely cause a severe bloody diarrhea, which should be reported to the doctor immediately for effective treatment. Prednisone pills and similar eyedrops may be used to decrease inflammation. Rarely, antibiotics may be injected into the eye.  Often, the pupil of the eye is dilated with eyedrops during the active infection to prevent scarring and to relieve pain.

It is not uncommon for untreated ocular toxoplasmosis to result in loss of vision. It is rare to experience serious side effects from medication used to treat toxoplasmosis. Armed with the knowledge to report side effects promptly to the doctor, you can minimize the chance of suffering from any permanent ill-effects from treatment.

Finally, notify your doctor if you had a toxoplasma infection in the past as it may be important to avoid intraocular steroid injections to prevent a return of infection.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2014-2022 Designs Unlimited of Florida.  All Rights Reserved.