MBBS KGMU What is panophthalmitis Acute suppurative inflammation amp necrosis of the structures of the eyeball including all the outer coats sclera amp cornea amp Tenons capsule ID: 277134
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Slide1
Panophthalmitis
MBBS
KGMUSlide2
What is panophthalmitis
Acute
suppurative
inflammation & necrosis
of the
structures of the eyeball, including
all the
outer coats - sclera & cornea & Tenon’s capsule.Slide3
Causes of panophthalmitis
Uncontrolled infection involving all coats of eyeball:
Penetrating injuries.
Fulminant post-operative
endophthalmitis
.
Bleb infection after
trabeculectomy
.
Buckle or band infection after retinal detachment surgery.
Spread of infection from sinuses, adnexa.
Ruptured globe due to
pre-existing
posterior
staphyloma/ necrotising
scleritis
.Slide4
Clinical picture of panophthalmitis
Systemic features of toxaemia:
Fever, headache, malaise.
Ocular movements restricted & painful.
Chemosis
of conjunctiva, lid oedema.
Edges of wound / corneal incision becomes yellowish & necrotic.
Corneal infiltrates & sloughing begins.
Hypopyon
worsens.
PL (perception of light) absent / doubtful.Slide5
PanophthalmitisSlide6
Sloughing cornea, chemosis
of conjunctivaSlide7
Orbital cellulitis / orbital abscessSlide8
Orbital cellulitisSlide9
Most dreaded complication is Cavernous sinus thrombosis Slide10
Treatment of panophthalmitis
Find the cause & any
associated debilitating
condition.
Treat the cause.
Medical treatment:
Systemic antibiotics.
Topical antibiotics – fortified.
Cycloplegics
.
Anti-inflammatory.
Surgical treatment:
Evisceration / Frill excision.Slide11
If
panophthalmitis
gets controlled by medical management, no further treatment may be needed
.
Phthisis
bulbi
may result.Slide12
When to eviscerate the eyeball.
Uncontrolled
infection & loss
of perception of
light despite adequate treatment.
Impending progression to orbital cellulitis.Slide13
Enucleation is contra-indicated in
panophthalmitis
Optic
nerve or its sheath should NOT be touched in
panophthalmitis
.
Infection may spread to intra-cranial space.Slide14
EviscerationSlide15
Empty scleral shell after eviscerating
intra-ocular contentsSlide16
Various designs of implantsSlide17
Suturing of sclera & conjunctiva in different layersSlide18
Bio-integrable
porous hydroxyapatite implant (with vascularisation) + customised prosthesisSlide19
Implant inside scleral coat after evisceration
+ customised prosthesisSlide20
Prosthetic eyeSlide21
Socket
(complete healing after evisceration)
Prosthesis will be placed hereSlide22
Appearance after evisceration & prosthesisSlide23
Appearance after evisceration & prosthesisSlide24
Methods of removal of eye
Evisceration – only intra-ocular contents are removed.
Enucleation: Intact globe is removed. Optic nerve & muscles are cut.
Exenteration
: All contents of orbit, including the periosteum, are removed.Slide25
EnucleationSlide26
Steps of enucleationSlide27
Exenterated orbitSlide28
Orbital prosthesis after
exenterationSlide29
Orbital prosthesisSlide30
Frill excision of sclera
During evisceration sclera is found to be
necrosed
& friable.
Suturing might not be possible.
Enucleation is contra-indicated.Slide31
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