II. Definitions

  1. Endophthalmitis
    1. Purulent inflammation of the vitreus humor and Aqueous Humor
    2. Typically due to eye infection but may also occur with signficant Eye Trauma (e.g. Mechanical Globe Injury)

III. Pathophysiology

  1. Typically due to Bacterial eye infection
    1. Coagulase negative Staphylococcus is the most common organism
    2. Endogenous Endophthalmitis, a hematogenous spread from other sites may also rarely occur (see below)
  2. Post-Traumatic Endophthalmitis
    1. May also be caused by Bacillus and Streptococcus species

IV. Causes

  1. Corneal Injury
  2. Corneal infection (Keratitis)
  3. Eye surgery
    1. Acute Post-Cataract Endophthalmitis (75% present in first week, may occur up to 6 weeks after surgery)
    2. Glaucoma filtering surgery
  4. Endogenous Endophthalmitis
    1. Rare Hematogenous spread of infection from other sites (e.g. Urinary Tract Infection)
    2. Risk factors include Alcoholism, Diabetes Mellitus and Cardiovascular disease

V. Differential Diagnosis

VI. Symptoms

  1. Severe Eye Pain
  2. Acute Vision Loss (over prior 24 hours)

VII. Signs

  1. Typically afebrile
  2. Eyelid Swelling
  3. Decreased Visual Acuity
  4. Visual Floaters
  5. Conjunctival injection, edema and hyperemia
  6. Corneal haziness or clouding
  7. Hypopyon
  8. Anterior chamber cells and flare (Iritis)
  9. Pupil abnormality

VIII. Management

  1. Intravenous Antibiotics
  2. Emergent ophthalmology evaluation
    1. Aspiration of Aqueous Humor and vitreous humor for Gram Stain and culture
      1. A negative culture does not exclude Bacterial Infection
    2. Intravitreal antibiotic injection
    3. Vitrectomy in cases of severe Vision Loss (patient only maintains light Perception)
    4. Corticosteroids and cyloplegics may be indicate in some cases

IX. Prognosis

  1. Recovery to 20/40 Vision in 50% of cases
  2. Chronic loss of useful Vision in 10% of cases

X. References

  1. Trobe (2012) Physician's Guide to Eye Care, AA0, p. 70
  2. Sales, Patel and Patel (2019) Crit Dec Emerg Med 33(12): 3-13
  3. Sadiq (2015) J Ophthalmic Inflamm Infect 5(1):32 +PMID: 26525563 [PubMed]

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