Endophthalmitis

Intraocular Inflammation

What is Endophthalmitis?

Endophthalmitis is an extensive infection of the inside of the eye (intraocular). It can include all layers, the inner vitreous and the sclera. It is usually caused by a bacteria introduced into the eye during eye surgery, but can also be a serious complication of a penetrating eye injury, infections in the body (systemic), or infections from IV drug use.

How is it diagnosed?

History: When endophthalmitis occurs as a post-operative complication, symptoms will occur 12 to 72 hours after surgery. Pain that is out of proportion to the amount of inflammation can be an early sign. Later signs include decreased vision and dark areas in the visual field (floaters). Pain may not be present if the infection is caused by an organism that is not very potent.

Physical exam: A pus-like discharge may be present. The lids will be swollen and the eye will be red but these features may not be prominent. Congestion (infection), swelling of the conjunctiva around the cornea (chemosis), increased cells and flare may be seen. Corneal edema is present in spite of normal intraocular pressure. The red reflex may be absent due to clouding of the fluid in the eye (vitreous humor). There may be opaque material suspended within the vitreous.

Tests: Visual acuity is tested and will be poor. The eye may be tapped with a vitrectomy instrument to obtain some of the vitreous humor for microscopic exam and culture. An organism will not be able to be cultured in about one-fourth of all cases.

How is Endophthalmitis treated?

Endophthalmitis is an emergency and must be treated immediately. The delay of a few hours can result in permanent blindness. Part of the vitreous fluid may be removed to dilute toxins produced by the bacteria and to decrease the numbers of bacteria in the eye (vitrectomy). An antibiotic is then injected into the vitreous and corticosteroids may also be injected to decrease inflammation. Intravenous antibiotics may be given for a period of time, although the benefits of this are as yet unproved.

Medications

Information Brand Generic Label Rating
Fluconazole Diflucan Fluconazole
Prednisone Deltasone Prednisone

What might complicate it?

The vitreous fluid may liquefy and form an abscess. Retinal detachment may occur.

Predicted outcome

The visual outcome varies widely. Depending on the causative organism, early, aggressive treatment can result in a good outcome. Any delay in treatment will adversely affect the outcome and can result in decreased vision or blindness in the affected eye.

Alternatives

Panophthalmitis is another possible diagnosis.

Appropriate specialists

Ophthalmologist and posterior segment specialist.

Last updated 5 October 2011


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