Endophthalmitis
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⚠️ 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.
