Endophthalmitis
Background
Eye anatomy.
- Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous chambers)
- Staphylococcus, Streptococcus, Bacillus cereus
- Frequently leads to loss of vision (ocular emergency)
Causes
- Cataract surgery
- Usually within 6 weeks
- Globe Rupture
- Penetrating eye trauma more at risk than blunt eye trauma
- Foreign body
- Extension of keratitis
- Hematogenous spread/endogenous (rare)
Clinical Features
Endophthalmitis from retained foreign body
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Inspect of lid, cornea, sclera
- Slit lamp exam
- Intraocular pressure
- After exclusion of Globe Rupture
- Bloodwork (CBC, BMP, ESR, CRP) only if considering endogenous endophthalmitis
- Ocular ultrasound to look for alternative diagnosis
- After exclusion of Globe Rupture
Management
- Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal antibiotics)
- Systemic antibiotics for endogenous endophthalmitis (rare cause)
- Systemic antibiotics for other etiologies is controversial
- Antibiotic prophylaxis in Globe Rupture reduces incidence of endophthalmitis to <1%
- tetanus, if indicated
Disposition
- Admit
See Also
- Eye Algorithm (Main)
- Globe Rupture
References
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