About Dr Brian Ang

Endophthalmitis Prevention: Reduce Your Risk of Infection

What is endophthalmitis?

Endophthalmitis is inflammation throughout the entire eyeball, usually due to severe infection. It is one of the most devastating complications following eye surgery. Prompt treatment with antibiotic injections into the eyeball is necessary to save the eye from becoming blind.

Picture of an eye with endophthalmitis. Note the pus collection in the anterior chamber (hypopyon) associated with a cloudy cornea. This is an indication of very severe inflammation in the eye. If your eye ever looks like this, make sure you contact your ophthalmologist urgently for immediately examination and treatment.

(Image adapted from the internet)

The key therefore is to prevent the infection from occurring in the first place. For this reason, virtually all ophthalmologists are very meticulous in their infection control preparation before and during surgery.

Measures just prior to surgery:
      – Using a clean theatre suite with positive pressure ventilation
      – Meticulous scrubbing of hands with povidone iodine or chlorhexidine
      – Wearing sterile theatre gowns and gloves
      – Wearing face masks
      – Cleaning your eye and face with povidone iodine or chlorhexidine
      – Draping your face with a sterile drape

Measures during surgery:
      – Using sterile and disposable instruments
      – Using a no-touch technique
      – Minimizing surgical time
      – Ensuring all wounds are properly closed and watertight
      – Antibiotic infusion during surgery and/or injection at the end of surgery

(Image adapted from the internet)

A lot of preparation takes place before the actual eye operation to lower the risk of eye infection. Ophthalmologists wear face masks, sterile gloves and sterile theatre gowns not for the aesthetic value, but to avoid contamination during surgery.

These measures have reduced the risk of endophthalmitis to below less than 0.1%. This means that when you undergo eye surgery, your chance of going blind from severe eye infection is less than 1 in 1000. The risk of infection is higher if you already have a pre-existing eye infection or infection elsewhere, poorly controlled diabetes mellitus, and poor eye hygiene.

Although the risk is already very low, why not lower it even further? You do not want to be the 1 in 1000 who develops endophthalmitis. You can achieve this by following these 5 golden rules of endophthalmitis prevention:

Endophthalmitis prevention tip #1: treat blepharitis

Blepharitis is the inflammation of the eyelids and the lid margins. This can occur due to colonization by the Staphylococcus bacteria. And it is not really a good idea to have colonies of bacteria on your eyelids during your recovery after surgery.

(Image adapted from the internet)

If you have blepharitis, you should make sure that you clean your eyelids with lid scrubs and baby shampoo at least daily for the 1 month period before and after surgery. Eyelid hygiene reduces the bacterial load on your eyelids and thus lowers the risk of spreading into your eye to cause an infection.

Endophthalmitis prevention tip #2: antibiotics

This approach is controversial. Some ophthalmologists believe that taking a course of broad-spectrum antibiotic eye drops (such as chloramphenicol or moxifloxacin) for a few days prior to surgery will reduce the risk of subsequent eye infection. The rationale is that the conjunctiva itself normally has colonies of bacteria, and these could potentially infect the eye after surgery. Antibiotic eye drops should therefore theoretically reduce the amount of bacteria in the conjunctiva and lower the risk of infection.

However, there is no clinical evidence that doing this actually reduces the risk of endophthalmitis. Other ophthalmologists point out that giving out antibiotics routinely before surgery may increase the chances of bacterial resistance to the antibiotic. If you are prone to eye infections or have a predisposing risk factor for endophthalmitis, then preoperative antibiotic eye drops may be beneficial for you. Discuss this with your ophthalmologist if you are keen to use antibiotics before surgery.

Endophthalmitis prevention tip #3: postoperative drops

After surgery, you will be given some eye drops. These eye drops are usually a combination of steroid (to reduce inflammation) and antibiotic. Antibiotic eye drops following eye surgery (unlike before surgery) is an accepted practice. Most ophthalmologists usually give a course of eye drops that lasts up to 6 weeks after surgery. Commonly used antibiotics after surgery include chloramphenicolofloxacinmoxifloxacin and tobramycin.

However, it is one thing to be prescribed antibiotic eye drops and quite another to actually use them. You might wonder what all these drops are for, especially once your eye starts to feel better. However, these eye drops were prescribed for a reason. So make sure that you instil the prescribed eye drops as instructed for the best outcome for your eye.

Endophthalmitis prevention tip #4: hand hygiene

Make sure you wash your hands thoroughly before and after you touch your eyes, especially when you have to instil your eye drops. Your hands pick up lots of dirt, germs and bacteria by contact with just about everything. Watch out for your nails and fingertips because they will accumulate more bacteria than most other parts of your hand. Also try to refrain from rubbing your eyes unnecessarily.

Washing your hands (your fingertips in particular) reduces the amount of dirt and bacteria. This in turn, will reduce the risk of contamination when you are instilling the eye drops. There really is no excuse for not washing and cleaning your hands before any contact with your eye.

Endophthalmitis prevention tip #5: environment

Always make sure that your eye is in an environment that is as clean as possible. Avoid dusty or smoky areas. This includes not doing any dusting or major cleaning while you recover from your eye surgery. Swimming is a no-no for the first few weeks after surgery. You do not want swimming pool water anywhere near your eye because it teems with germs and bacteria despite being chlorinated. Even wearing goggles cannot guarantee that swimming pool water will not get into your eye.

Do not share towels or handkerchiefs. If possible, use a fresh and clean face towel every time you clean your face. Even better if you are able to use cooled boiled water to wash your face. Finally, avoid contact lens wear unless it is specifically required in your case.

Unfortunately, the risk of endophthalmitis after eye surgery cannot be decreased to completely nil. But you ought to do what you can to minimize your risk of developing postoperative eye infection. If you are unclear about what postoperative eye care measures that you should be undertaking, you should always check and consult with your ophthalmologist.


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