Cataract Surgery Risks: Can Chronic Rhinitis Lead to Endophthalmitis?

Q: Cataract Surgery Risks: Can Chronic Rhinitis Lead to Endophthalmitis?

Hello, Dong Dong： Before cataract surgery, local disinfection is performed, and the risk of bacterial infection leading to endophthalmitis is generally low. <br>The use of antibiotic eye drops and the cleaning of the conjunctival sac and tear ducts may depend on the physician's p

Cataracts and endophthalmitis?

Hello Doctor: I would like to ask about the issue of endophthalmitis occurring after cataract surgery.
If a cataract patient has chronic rhinitis prior to surgery, which involves the presence of nasal discharge, could the bacteria from the rhinitis enter the eye and cause an infection leading to endophthalmitis? Some doctors suggest using antibiotic eye drops and performing conjunctival sac and tear duct irrigation three days before surgery to reduce the risk.
However, I have not heard of this being done before surgery in general.

Dong Dong, 40~49 year old female. Ask Date: 2017/04/16

Dr. Gao Pilin reply Ophthalmology

Hello, Dong Dong: Before cataract surgery, local disinfection is performed, and the risk of bacterial infection leading to endophthalmitis is generally low.
The use of antibiotic eye drops and the cleaning of the conjunctival sac and tear ducts may depend on the physician's personal practice.
In Taiwan, the ophthalmology department at Puzi Hospital is open Monday to Friday from 8:00 AM to 12:00 PM and Wednesday afternoons from 1:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is necessary to seek medical attention at a healthcare facility.
I hope to have the opportunity to serve you.
Gao Pi-Lin

Reply Date: 2017/04/16

More Info

Cataract surgery is a common and generally safe procedure that can significantly improve vision. However, like any surgical intervention, it carries some risks, one of which is endophthalmitis, an infection inside the eye. Your question about the potential link between chronic rhinitis and endophthalmitis is quite insightful and highlights the importance of understanding how infections can spread in the body.

Chronic rhinitis, characterized by persistent nasal inflammation and mucus production, can indeed harbor bacteria. However, the risk of these bacteria directly causing endophthalmitis after cataract surgery is relatively low. The eye is a sterile environment, and several mechanisms help prevent infections from spreading from the nasal cavity to the eye. The anatomical barriers, such as the nasolacrimal duct, typically prevent bacteria from moving from the nasal passages to the ocular surface.

That said, there are certain scenarios where an upper respiratory infection, including chronic rhinitis, could potentially increase the risk of postoperative infections. For instance, if a patient has a significant bacterial load in their nasal secretions, there might be a theoretical risk during surgery, especially if proper sterile techniques are not followed. This is why surgeons often emphasize the importance of preoperative assessments and may recommend treatments to reduce the risk of infection.

The use of antibiotic eye drops before surgery, as you mentioned, is a common practice. These drops are intended to reduce the bacterial load on the ocular surface, thereby minimizing the risk of endophthalmitis. Additionally, cleaning the conjunctival sac and the tear ducts can help remove any potential contaminants that could lead to infection. While not all surgeons may routinely perform these steps, many do advocate for them, especially in patients with known risk factors for infection.

It's also worth noting that the incidence of endophthalmitis after cataract surgery is quite low, estimated to be around 0.1% to 0.5%. Most patients do not experience complications, and the benefits of improved vision typically outweigh the risks. However, if you have chronic rhinitis or any other underlying conditions, it's essential to discuss these with your ophthalmologist before surgery. They may tailor their preoperative protocol to address your specific situation, which could include additional antibiotic prophylaxis or other preventive measures.

In conclusion, while chronic rhinitis can theoretically pose a risk for infections, the direct link to endophthalmitis post-cataract surgery is not well-established. The use of preoperative antibiotics and cleaning procedures is a proactive approach to minimize any potential risks. Always communicate openly with your healthcare provider about your concerns and medical history, as they can provide personalized advice and reassurance based on your specific circumstances.

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