Panophthalmitis is a total purulent inflammation and melting of all structures and membranes of the eyeball. With panophthalmitis, there is a sharp pain in the eye socket and in the head on the side of the lesion, lacrimation, photophobia, swelling and chemosis of the conjunctiva, blepharospasm, chills, fever, vision loss. Diagnosis of panophthalmitis is based on the data of diaphanoscopy, biomicroscopy, ophthalmoscopy, ultrasound of the eye, bacteriological seeding. Treatment of panophthalmitis requires active local and systemic antibiotic therapy; in some cases, evisceration or enucleation of the eyeball.
Panophthalmitis is the extreme and most severe form of inflammation of the organ of vision, in which all the membranes of the eye and the surrounding soft tissues (eyelids, fiber, muscles) are involved in the purulent process. The seriousness of the problem lies in the fact that panophthalmitis often leads to death and subsequent atrophy of the eye. Protective mechanisms are concentrated in the accessory apparatus of the eye (eyelids, lacrimal glands), therefore, the penetration of infection into the eyeball is accompanied by rapid and unhindered reproduction of microorganisms. As a result, with panophthalmitis, purulent inflammation and melting are exposed to all layers of the eyeball.
Panophthalmitis can be caused by exogenous or endogenous penetration of infection into the eyeball. In this case, the causative agents are usually streptococci, Staphylococci, pneumococci, Pseudomonas aeruginosa and E. coli, Mycobacterium tuberculosis.
In ophthalmology, penetrating wounds of the eye (mechanical damage, foreign bodies, burns) most often lead to panophthalmitis. In this case, the purulent infection penetrates deep into the eyeball through the wound canal. Also, panophthalmitis can be a consequence of bacterial keratitis, perforation of a purulent ulcer of the cornea, severe course of uveitis, blennorrhea, trachoma, abscess of the eyelids, phlegmon of the eye socket, endophthalmitis.
Endogenous infection of eye structures is less common and may be associated with metastatic introduction of bacterial infection from distant purulent foci. The occurrence of panophthalmitis is possible due to pneumonia, tuberculosis, furunculosis, postoperative or postpartum sepsis, meningitis, typhus, sinusitis.
With penetrating wounds of the eyeball, panophthalmitis develops rapidly, within 2-3 days. Purulent damage to the structures of the eye is accompanied by severe pain in the eyeball, lacrimation, photophobia, reflex blepharospasm, rapid and significant decrease in vision. Objective changes are characterized by sharp hyperemia, swelling of the conjunctiva and eyelids, which can lead to chemosis – infringement of the eyelids of the mucous membrane of the eye. The cornea becomes cloudy and edematous; the iris melts; pus accumulates in the anterior chamber of the eye; purulent exudate is also found in the vitreous body. With panophthalmitis, there is a rapid and significant decrease in vision, up to light perception or blindness.
With further progression of panophthalmitis, pus penetrates under the conjunctiva, infiltrates peribulbar tissues, spreads into the tenon capsule, increasing tissue edema and leading to the development of inflammatory exophthalmos. The mobility of the eyeball is sharply limited. Perforation of the sclera may occur with the release of pus outside. In the future, after 6-8 weeks, the eye shrinks and atrophies.
With anaerobic panophthalmitis, the purulent process develops rapidly: a coffee-colored discharge with gas bubbles appears from the anterior chamber, blindness occurs already on the day of the eye injury.
In addition to local changes, panophthalmitis is accompanied by common symptoms: intoxication, headache, fever with chills, vomiting. The purulent process can pass to the meninges with the development of meningitis, the formation of a brain abscess.
For the diagnosis of panphotalmitis, the presence of a history of penetrating eye wounds and infectious foci in the body is of paramount importance.
Objective signs of panophthalmitis (changes in the conjunctiva, iris, accumulation of purulent exudate in the anterior chamber of the eye and vitreous body) are detected by an ophthalmologist when examining the structures of the eye (diaphanoscopy, biomicroscopy). If it is possible to examine the fundus with ophthalmoscopy, dilated retinal veins are determined. Ultrasound scanning allows you to identify foci of destruction of deep structures of the eye.
To determine the microbial flora that caused the development of panophthalmitis, corneal paracentesis is performed to obtain purulent exudate and its bacteriological seeding.
Differential diagnosis of panophthalmitis is carried out with endophthalmitis, which does not proceed so violently.
Panophthalmitis requires early and intensive treatment. The basis of pathogenetic therapy of panophthalmitis is the appointment of massive doses of antibiotics (benzylpenicillin, streptomycin, monomycin, gentamicin, etc.). Antibiotics are administered intramuscularly, intravenously, in the form of retrobulbar, subconjunctival injections. In some cases, vitrectomy and intravitreal administration of antimicrobials are resorted to. Instillations and baths with trypsin solution are shown. To eliminate the phenomena of general intoxication, intravenous infusions of saline solutions are carried out.
Conservative treatment of panophthalmitis is not always successful, so it is often necessary to resort to evisceration or enucleation of the eyeball with subsequent ocular replacement.
Prognosis and prevention
When complex treatment of panophthalmitis is started in a timely manner, in some cases it is possible to preserve the eyeball and residual vision. Most often, the outcome of panophthalmitis is the death of the eye with its subsequent atrophy. The prognosis for visual function and life with panophthalmitis is always extremely serious.
The main role in the prevention of panophthalmitis belongs to the prevention of eye injuries, the rehabilitation of infectious foci in the body, the treatment of inflammation of the structures of the eye and its accessory apparatus. In case of eye injuries, preventive local and general antibiotic therapy should be carried out in the first hours after the injury.