Understanding Nursing

Care Guide For

Endophtalmitis
Dewanti Widya Astari SKep., Ns
M.Kep

IKATAN PERAWAT MATA INDONESIA

(IKPAMI)
2021
INCIDENCE ENDOPHTALMITIS
WORLDWIDE
Endophthalmitis post
operasi katarak yang paling
sering terjadi yaitu sekitar
0,1- 0,3% dari operasi lain

Endophthalmitis setelah injeksi

intravitreal diperkirakan sekitar
0,029% dari 10.000 suntikan

Endophthalmitis pasca trauma terjadi

4-13% dari semua cedera tembus
● Endophthalmitis is a
serious eye infection
that can lead to
permanent harm,
including blindness
(Hathaway et al, 2019)
 CLASSIFICATION

ENDOGEN EKSOGEN
systemic risk factors that may occur after ocular trauma,
spread bacteria or fungi following a corneal infection,
from the primary source of or after eye surgery
infection into the eye particularly cataract surgery
 SIGN SYMPTOMS

Penglihatan kabur
01 (94,3%)
01 Hipopion (85%)

02 Mata merah (82,1%) Media kabur (79%) da

02 tajam penglihata
hanya LP (26%)
03 Nyeri (74%)

Kelopak mata bengkak

04 (34,5%)
 Pathogens Identified in Reports of Post-Cataract
Endophthalmitis Events (n = 37)

Mercury Mars Saturn

01 02 03
Mercury is the closest Despite being red, Mars Saturn is composed of
planet to the Sun is actually a cold place hydrogen and helium
Etiology (%) of postoperative endophthalmitis
in various regions (ESCRS Guidelines, 2013)
 CAUSATIVE ORGANISMS
Acute Post-op Delayed Post-op Post- Traumatic Endogenous

Gram +ve: Bacteria: Bacteria: Bacteria:

S. epidermidis Propionibacterium Bacillus Bacillus cereus
S. aureus acne S.epidermidis Streptococci
Streptococci Streptococci Streptococci S.aureus
Gram –ve: Fungi: Fungi: N.meningitides
Pseudomonas Aspergillus Fusarium H.influenzae
H.influenzae Candida Fungi:
Klebsiella spp Fusarium Mucor
E. coli Penicillium Candida
Bacillus spp
Anaerobes
 Strategies for Healthcare Providers to
Reduce the Risk of Contamination
(Hathaway et al, 2019; Verma et al, 2017 &
ESRC 2013)

Preoperative risk Postoperative risk

reduction strategies reduction strategies

Intraoperative risk reduction Environmental risk

strategies reduction strategies
Preoperative risk reduction strategies

Sterilization protocols
Prepare medication just prior to the
procedure
Never store or carry medications in
personal clothing or pockets.
Intraoperative risk reduction strategies

❖ Use povidone-iodine
❖ Drape the patient’s eyelid and lashes precisely
❖ Facemasks should be worn by the surgeon and scrubbed
personnel.
❖ Prior to administering ophthalmic drops, carefully
remove the top of the bottle and place it in a clean,
protected area.
❖ The eye drop tip must never come in contact with
the patient’s eyelid, eyelashes, or surface of the eye
❖ Surgical instruments and handpieces
❖ disinfection and sterilization process.
Postoperative
risk reduction
strategies
● Remind patients not to wear eye makeup
until the surgeon approves.
● Education and return demonstration
● Discharge instructions, including wearing
the postoperative eye shield as directed,
avoiding eye rubbing, and following
postoperative eye drop regimen
Environmental risk reduction
strategies
❖ Clean the surgical
environment between
patients.

❖ Regular maintenance
of the ventilation filter
system is
recommended in the
surgical suite
 Human
Response
(Pavlov Theory)

(Nursalam, 2013)
 NURSING DIAGNOSIS : PAIN

Related factors:
An irritation of the nerve endings.
The presence of the inflammatory process.

Possibility evidenced by: INTERVENTION

Reported photophobia, pain.
Changes in vital signs.
Disruption of sleep patterns.
Outcomes :
Pain reported lost / controlled.
Shows the posture relaxed and able to sleep / rest
appropriately.
1 Assess the client's level of perceived
pain.
2 Observation of vital signs.
3 Give a warm wet compress.
4 Give irrigation.
5. Give medication as prescribed to
control pain.
Nursing Diagnosis : Disturbed Sensory
Perception (specify: visual)
Intervention
Related factors:
Determine sharpness, note
Inflammation of the interior of the
whether one or both eyes are
camera eye.
involved
Photophobia, impaired sensory
acceptance.
Get a functional description
of what can and can not be
Possibility evidenced by:
seen by the client.
The reduced acuity, visual disturbances.
Changes in response to stimuli normally.
Orient the patient to the
environment, the staff,
Outcomes:
everyone else in the area.
Outlook have increased.
Adapt the environment to the
Demonstrate the ability to use the
visual needs of clients.
maximum of
the existing views.
REFERENCES
1. Danielescu, C., Anton, N., Stanca, H. T., & Munteanu, M. (2020). Endogenous Endophthalmitis: A Review of Case Series Published
between 2011 and 2020. Journal of Ophthalmology, 2020. https://doi.org/https://doi.org/10.1155/2020/8869590
2. Galor, A., Goldhardt, R., Wellik, S. R., Gregori, N. Z., & Flynn, H. W. (2013). Management Strategies to Reduce Risk of Postoperative
Infections. Curr Ophthalmol Rep 161-168. https://doi.org/10.1007/s40135-013-0021-5
3. Hathaway, L., Kepner, S., & Jones, R. (2019). Incidence and Impact of Reported Infectious Endophthalmitis Events Following
Cataract Surgery in Pennsylvania Ambulatory Surgery Centers. Patient Safety, 1(2), 24-35.
https://doi.org/https://doi.org/10.33940/infection/2019.12.3
4. Lalit Verma, & Chakravarti, A. (2017). Prevention and management of postoperative endophthalmitis: A case-based
5. approach. Indian Journal of Ophthalmology, 65:1396-1402.
6. McKenna, P., & McCutcheon, K. (2014). Pre-intravitrael injection preparation: endophthalmitis prevention and the importance of
povidone-iodine. International Journal of Ophthalmic Practice, Vol 5 No 5.
7. Nursalam. (2020). Literature Systematic Review Pada Pendidikan Kesehatan. Fakultas Keperawatan Universitas Airlangga.
8. [Record #19 is using a reference type undefined in this output style.]
9. Sadiq, M. A., Muhammad Hassan, Aniruddha Agarwal, Salman Sarwar, Shafak Toufeeq, Mohamed K. Soliman, Mostafa Hanout,
Yasir Jamal Sepah, Do, D. V., & Nguyen, Q. D. (2015). Endogenous endophthalmitis: diagnosis, management, and prognosis. Journal
of Ophthalmic Inflammation and Infection, 5:32 https://doi.org/10.1186/s12348-015-0063-y
10. Tzu-Heng, W., Chang H-C, & C-H, C. (2018). Epidemiology and Mortality-Related Prognostic Factors in Endophthalmitis. Invest
Ophthalmol Vis Sci, 2487-2494. https://doi.org/https://doi.org/ 10.1167/iovs.18-23783
11. Verma, L., & Chakravarti, A. (2017). Prevention and management of postoperative endophthalmitis: A case‐based approach Indian
Journal Ophthalmol, 65:1396-402. https://doi.org/10.4103/ijo.IJO_1058_17
OPTOMETRY ICONS