Tag Archives: non-steroid

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.

NSAID Eye Drops

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What are NSAID Eye Drops?

NSAID eye drops are prescription medications used to treat macular edema or reduce pain and inflammation. NSAID stands for Non-Steroidal Anti-Inflammatory Drug. This class of medication is separated from steroids by mechanism of action, effectiveness, and side effects. There are a number of NSAID eye drop brands available. Examples include Ketorolac, Acular, Acuvail, Voltaren, Nevanac, Ilevro, Xibrom, Bromday, Prolenza, Ocufen, and Bromsite.

How do NSAIDS work?

NSAIDS work by inhibiting the COX enzyme that produces specific prostaglandins, which promote inflammation. Prostaglandins are a major class of inflammatory mediators in the body. There are other mediators of inflammation that sometimes need to be controlled, so steroid eye drops are often used in addition to NSAIDS.

There is conflicting evidence as to whether one NSAID drug is better than another. Some believe that Nevanac and Ilevro are better for pain control. Others believe that Voltaren is better to control signs of inflammation inside the eye.

How does the doctor choose which NSAID to use?

In some cases the doctor has had good experience with a specific agent for a given situation. In other cases the choice may be guided by convenience and cost. For convenience some drops may be used once or twice a day (e.g. Ilevro, Xibrom, Bromday, Prolenza, and Bromsite). Although their prices vary, they tend to be expensive in comparison to generic drugs.

As an alternative, other NSAIDS are used more frequently, but cost less. Acular and Voltaren are available in generic formulations that cost under $20. These drops are frequently used four times a day. They are less expensive even though more eye drops are used per day. They may cause eye irritation in some patients.

If you have strong preferences, be sure to communicate with your doctor to be given the best NSAID eye drops for your situation. Be sure to use your eye drops exactly as prescribed and keep all appointments as scheduled in order to determine the effect of the medication and to look for side effects.

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.