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Endophthalmitis

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Endophthalmitis

  • See Also
  • Definitions
  1. Endophthalmitis
    1. Purulent inflammation of the vitreus humor and Aqueous Humor
    2. Typically due to eye infection
  • Pathophysiology
  1. Typically due to Bacterial eye infection
    1. Coagulase negative Staphylococcus is the most common organism
  • 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. Hematogenous spread of infection (rare)
  • Differential Diagnosis
  • Symptoms
  1. Severe Eye Pain
  2. Acute Vision Loss (over prior 24 hours)
  • 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)
  • Management
  1. 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)
  • Prognosis
  1. Recovery to 20/40 vision in 50% of cases
  2. Chronic loss of useful vision in 10% of cases
  • 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