Endophthalmitis

Severe, sight-threatening intraocular inflammatory condition caused by infection of the vitreous and/or aqueous humor, often extending to adjacent intraocular structures

Aetiology

Exogenous Endophthalmitis

  1. Postoperative (most common)
      • Following cataract surgery, intravitreal injections, or other intraocular procedures
      • Common organisms:
        • Staphylococcus epidermidis
        • Staphylococcus aureus
        • Streptococcus species
  1. Post-traumatic
      • Following penetrating ocular injury, especially with retained intraocular foreign body
      • Common organisms:
        • Bacillus species
        • Gram-negative bacteria
        • Fungal pathogens

Endogenous Endophthalmitis

  • Results from hematogenous spread of infection from a distant systemic focus
  • Common organisms:
    • Candida species (most common)
    • Aspergillus species
    • Gram-negative bacteria (e.g., Klebsiella pneumoniae)
  • Predisposing conditions:
    • Diabetes mellitus
    • Immunosuppression
    • Intravenous drug use
    • Indwelling catheters

Clinical presentation

Symptoms

  • Sudden, severe reduction in vision
  • Ocular pain
  • Red eye
  • Photophobia
  • Floaters

Signs

  • Marked conjunctival hyperemia and chemosis
  • Corneal edema
  • Anterior chamber reaction with hypopyon
  • Vitritis with absent or poor red reflex
  • Elevated intraocular pressure (variable)
  • Eyelid edema in severe cases
notion image
notion image

Investigations

Microbiological Studies

  • Vitreous and/or aqueous tap for Gram stain, culture, and sensitivity
  • Blood cultures in suspected endogenous endophthalmitis

Imaging

  • B-scan ultrasonography if fundus view is obscured
  • Orbital imaging if panophthalmitis is suspected

Management

Endophthalmitis requires urgent intervention.

Medical Treatment

  • Intravitreal broad-spectrum antibiotics (immediately after vitreous tap):
    • Vancomycin 1mg/0.1mL (Gram-positive coverage)
    • Ceftazidime 2.25mg/0.1mL, Amikacin 0.4mg/0.1mL, Gentamycin 0.2mg/0.1mL (Gram-negative coverage)
  • Intravitreal antifungal agents (e.g., amphotericin B) if fungal infection is suspected
  • Systemic antibiotics in selected cases
  • Topical antibiotics and corticosteroids as adjuncts

B. Surgical Treatment

  • Pars plana vitrectomy:
    • Indicated in severe cases, particularly when initial visual acuity is light perception only
    • Helps remove infective organisms and inflammatory debris