Endophthalmitis is a rare, but potentially devastating, eye infection that can cause permanent loss of vision. Advances in instrument sterilization practices, more effective antisepsis of the eye before surgery, and more proactive patient and staff education are helping to ensure these infections don't occur.
"When physicians perform outpatient surgery or administer injections in an office setting, infections rates are relatively low," says Abdhish R. Bhavsar, MD, clinical spokes-person for the American Academy of Ophthalmology and director of the Retina Center in Minneapolis.
So, what leads to these exceedingly rare infections at surgery centers and ophthalmology offices? "Occasionally," says Dr. Bhavsar, "there are breaches in sterility."
Dr. Bhavsar says the two most important endophthalmitis prevention steps are proper sterilization of instrumentation, and preoperative and intraoperative antisepsis of the ocular surface as well as the eye lids and lashes. A large portion of his instrumentation is single-use, and the remaining multi-use tools are sterilized according to strict guidelines. For antisepsis, he usually prepares the skin around the eyelids and the ocular surface with povidone-iodine. He often employs a topical anesthetic before the povidone-iodine application because the latter can sting.
Dr. Bhavsar suggests reacting rapidly and performing a root cause analysis when cases occur. "Examine all of your processes to determine if there are any risk factors that could be leading to infection," he says. "For example, infections might be linked to sterilizing instruments in a different manner or using a different solution in the eye."
Dr. Bhavsar says facilities should self-audit to identify these issues before any cases occur. "We all should be auditing ourselves continuously," he says.
The onset of postoperative endophthalmitis symptoms varies, according to Dr. Bhavsar, although he says most infections become evident within the first week. "Symptoms include decreased vision, pain, light sensitivity, increased floaters and increased discharge from the surface of the eye," he says.
It's vital to educate patients on recognizing infections so they know to come in as soon as possible when symptoms develop. "We want the patient to come in the same day of noticing symptoms," says Dr. Bhavsar. "All patients who have procedures on the eye need to be warned about the same symptomatology."
Dr. Bhavsar describes postoperative infection symptoms for patients before surgery, and reinforces that information after surgery, including within discharge paperwork. He then brings it up again on the first postoperative visit.
Outcomes for endophthalmitis patients vary. "In cases where we can treat the infection earlier, or when the case is less severe, generally the vision prognosis is better," says Dr. Bhavsar. "When cases are extremely severe, the prognosis is much more guarded or poor. Many patients who have this infection still recover vision to varying extents, and some recover vision very well. A high percentage end up with 20/40 vision, which is very good considering the eye had a severe infection."