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⚠️ Endophthalmitis is an ophthalmic emergency. It most often occurs after recent intraocular surgery, intravitreal injection, or penetrating eye trauma — cataract surgery is a classic cause. Suspected cases require same-day urgent ophthalmology assessment.
📖 About
- 🦠 Severe intraocular inflammation, usually caused by infection, affecting the internal eye tissues and fluids.
- ⏱️ Can rapidly cause irreversible visual loss if not treated promptly.
- 👥 Risk may be increased in people with diabetes, immunosuppression, IV drug use, indwelling lines, or systemic sepsis depending on the cause.
🧬 Aetiology
- 🔪 Exogenous: Most commonly after intraocular surgery, intravitreal injection, or penetrating trauma.
- 🩸 Endogenous: Haematogenous spread from a distant infective focus such as endocarditis, line sepsis, or candidaemia.
- 🦠 Pathogens: Common bacterial causes include coagulase-negative staphylococci, Staphylococcus aureus, and Gram-negative organisms such as Pseudomonas. Fungal causes such as Candida or Aspergillus are more likely with immunosuppression, IV drug use, prolonged antibiotics, or bloodstream infection.
👁️ Clinical Presentation
- 👓 Blurred vision or acute visual loss.
- 😖 Eye pain, redness, and photophobia.
- ⚪ Marked anterior chamber inflammation; a hypopyon may be visible.
- 🌫️ Vitritis may obscure the fundal view.
- 🍄 Fungal endogenous endophthalmitis may produce creamy-white chorioretinal lesions or fluffy vitreous opacities.
🔬 Investigations
- 🎯 Primarily a clinical ophthalmic emergency.
- 🧫 Aqueous and/or vitreous sampling for Gram stain, culture, and sometimes PCR.
- 🖼️ B-scan ocular ultrasound if media opacity prevents fundal assessment.
- 🔍 If endogenous disease is suspected, investigate for a systemic source with tests such as blood cultures and other targeted work-up.
💊 Management
- 🚨 Same-day urgent ophthalmology assessment.
- 💉 Management is specialist-led and usually includes intravitreal antimicrobials; empiric bacterial treatment often uses vancomycin + ceftazidime.
- 💊 Systemic antibiotics or antifungals may be needed, especially in endogenous infection or severe disease.
- 🔪 Vitrectomy may be indicated in severe disease, dense vitritis, or poor response to initial treatment.
- ❌ Topical therapy alone is inadequate.
- 🏥 Admission may be required depending on severity and treatment plan.
📚 References
