Endophthalmitis

Endophthalmitis from retained foreign body

Background

• Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus chambers)
  • Staphylococcus, Streptococcus, Bacillus cereus
• Frequently leads to loss of vision (ocular emergency)

Causes

• Cataract surgery
  • Usually within 6 weeks
• Globe Rupture
  • Penetrating eye trauma more at risk than blunt eye trauma
• Foreign body
• Extension of keratitis
• Hematogenous spread/endogenous (rare)

Clinical Features

1. Headache
2. Eye pain
3. Photophobia
4. Vision loss
5. Ocular discharge
6. May also see:
   1. Conjunctival/scleral injection
   2. Chemosis
   3. Hypopyon
   4. Uveitis

Work-Up

• Visual Acuity
• Inspect of lid, cornea, sclera
• Slit lamp exam
• Intraocular pressure
  • After exclusion of Globe Rupture
• Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis
• Ultrasound to look for alternative diagnosis
  • After exclusion of Globe Rupture

DDx

• Sterile postoperative inflammation
• Red Eye (Unilateral)
• Corneal Abrasion and Foreign Body
• Uveitis
• Vitreous Hemorrhage

Treatment

• Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal abx)
• Systemic antibiotics for endogenous endophthalmitis (rare cause)
  • Systemic antibiotics for other etiologies is controversial
  • Antibiotic prophylaxis in Globe Rupture reduces incidence of endophthalmitis to <1%
  • tetanus, if indicated

Disposition

• Admit

See Also

Eye Algorithm (Main) Globe Rupture

Source

Tintinalli Rosen's UpToDate