II. Definitions
- Endophthalmitis
- Purulent inflammation of the vitreus humor and Aqueous Humor
- Typically due to eye infection but may also occur with signficant Eye Trauma (e.g. Mechanical Globe Injury)
III. Pathophysiology
- Typically due to Bacterial eye infection
- Coagulase negative Staphylococcus is the most common organism
- Endogenous Endophthalmitis, a hematogenous spread from other sites may also rarely occur (see below)
- Post-Traumatic Endophthalmitis
- May also be caused by Bacillus and Streptococcus species
IV. Causes
- Corneal Injury
- Corneal infection (Keratitis)
- Eye surgery
- Acute Post-Cataract Endophthalmitis (75% present in first week, may occur up to 6 weeks after surgery)
- Glaucoma filtering surgery
- Endogenous Endophthalmitis
- Rare Hematogenous spread of infection from other sites (e.g. Urinary Tract Infection)
- Risk factors include Alcoholism, Diabetes Mellitus and Cardiovascular disease
V. Differential Diagnosis
VI. Symptoms
- Severe Eye Pain
- Acute Vision Loss (over prior 24 hours)
VII. Signs
- Typically afebrile
- Eyelid Swelling
- Decreased Visual Acuity
- Visual Floaters
- Conjunctival injection, edema and hyperemia
- Corneal haziness or clouding
- Hypopyon
- Anterior chamber cells and flare (Iritis)
- Pupil abnormality
VIII. Management
- Intravenous Antibiotics
- Emergent ophthalmology evaluation
- Aspiration of Aqueous Humor and vitreous humor for Gram Stain and culture
- A negative culture does not exclude Bacterial Infection
- Intravitreal Antibiotic injection
- Vitrectomy in cases of severe Vision Loss (patient only maintains light Perception)
- Corticosteroids and cyloplegics may be indicate in some cases
- Aspiration of Aqueous Humor and vitreous humor for Gram Stain and culture
IX. Prognosis
X. References
- Trobe (2012) Physician's Guide to Eye Care, AA0, p. 70
- Sales, Patel and Patel (2019) Crit Dec Emerg Med 33(12): 3-13
- Sadiq (2015) J Ophthalmic Inflamm Infect 5(1):32 +PMID: 26525563 [PubMed]