Endophthalmitis
Endophthalmitis is a vision-threatening suppurative infection of the aqueous and vitreous humors, most often exogenous after cataract or other intraocular surgery and less often endogenous from hematogenous seeding during bacteremia or candidemia. Diagnosis is clinical, confirmed by vitreous/aqueous tap, and treatment is emergent intravitreal antibiotics or antifungals with vitrectomy for severe cases.
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What this article covers
- Overview
A suppurative infection of the aqueous and vitreous humors: endophthalmitis is a true ophthalmologic emergency in which bacteria or fungi invade the interior of the eye, threatening irreversible vision loss within hours to days if untreated.
- Epidemiology
Postoperative endophthalmitis is the most common form: it is a rare complication of cataract surgery, the most frequently performed intraocular procedure, and typically presents within 7 days of surgery.
- Risk factors
Recent intraocular surgery, especially cataract surgery, is the leading risk factor for exogenous bacterial endophthalmitis.
- Pathophysiology
Exogenous inoculation of the aqueous and vitreous: during surgery, penetrating trauma, or an intravitreal injection, organisms from the ocular surface (conjunctival flora) or the environment gain…
- Clinical features
Eye pain and decreased vision are the hallmark presenting symptoms, developing acutely (within days of surgery or trauma) in exogenous disease or subacutely over days to weeks in endogenous disease.
- Differential diagnosis
Uveitis (iritis/iridocyclitis): can produce a hypopyon and painful red eye, but there is no recent surgery, trauma, or bloodstream infection, vitreous cultures are sterile, and the process responds…
- Diagnosis
Endophthalmitis is a clinical diagnosis of a vision-threatening intraocular infection, confirmed by aqueous and vitreous aspirate Gram stain and culture (with KOH/fungal stain and fungal culture…
- Management
First, obtain the vitreous/aqueous tap, then start empiric intravitreal antibiotics without waiting for culture results: vancomycin 1 mg in 0.1 mL intravitreal injection plus ceftazidime 2.25 mg in…
- Complications
Permanent vision loss or blindness is the most feared outcome and correlates directly with delay from symptom onset to intravitreal therapy.
- Prognosis
Time to treatment is the dominant determinant of visual outcome: earlier intravitreal therapy after symptom onset is associated with better preserved vision.
- Prevention
Screen every patient with candidemia with a dilated fundoscopic examination within 7 days of the first positive blood culture if nonneutropenic, or as soon as the neutrophil count recovers in a…
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