Makindo Medical Notes

Related Subjects: |Episcleritis |Scleritis |Assessing a Red eye |Acute Angle Closure Glaucoma |Allergic and Infective Conjunctivitis |Anterior and Posterior Uveitis |Atropine Sulfate |Herpes simplex keratitis (HSK) |Acute Blepharitis |Chalazion

⚠️ Endophthalmitis most commonly occurs as a complication of cataract surgery. It is an ophthalmic emergency and requires same-day referral.

📖 About

• 🦠 Infection involving both anterior and posterior chambers of the eye.
• 👥 More common in patients with diabetes, immunosuppression, or HIV infection.
• ⏱️ Can rapidly lead to irreversible visual loss if untreated.

🧬 Aetiology

• 🔪 Exogenous: Most commonly after penetrating trauma or intraocular surgery (especially cataract extraction).
• 🩸 Endogenous (haematogenous spread): Infection enters via the choroid/ciliary body from distant sites (e.g. endocarditis, line sepsis).
• 🦠 Pathogens: Bacterial (Gram-positive: Staph epidermidis, Staph aureus; Gram-negative: Pseudomonas, Klebsiella). Fungal (Candida, Aspergillus) in IV drug use, prolonged antibiotics, or immunosuppression.

👁️ Clinical Presentation

• Blurred vision or acute visual loss.
• Eye pain, redness, photophobia.
• Marked anterior chamber reaction → hypopyon may be visible.
• Vitritis (“headlight in the fog” appearance on fundoscopy).
• Fungal endophthalmitis (Candida): creamy-white retinal or chorioretinal lesions with fluffy “cotton-ball” appearance.

🔬 Investigations

• 🎯 Clinical diagnosis → ophthalmology emergency.
• 🧫 Vitreous/aqueous tap for Gram stain, culture, PCR.
• 🖼️ Ocular ultrasound (B-scan) if vitreous opacities obscure fundal view.
• 🔍 Systemic work-up if endogenous suspected (blood cultures, echocardiogram).

💊 Management

• 🚨 Same-day ophthalmology referral + admission.
• 💉 Intravitreal antibiotics (e.g. vancomycin + ceftazidime) or antifungals (e.g. amphotericin, voriconazole) depending on suspected cause.
• 💊 Systemic antibiotics/antifungals if endogenous or severe disease.
• 🔪 Vitrectomy: indicated in severe cases, dense vitreous abscess, or poor response to medical therapy.
• ❌ Topical therapy alone is inadequate.

📚 References

• Royal College of Ophthalmologists: Clinical Guidelines for Postoperative Endophthalmitis.
• BMJ Best Practice: Endophthalmitis overview.