Endophthalmitis

Background

  • Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous chambers)
  • 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

  • Headache
  • Eye pain
  • Photophobia
  • Vision loss
  • Ocular discharge
  • May also see:

Differential Diagnosis

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

  • Inspect of lid, cornea, sclera
  • Slit lamp exam
  • Intraocular pressure
  • Bloodwork (CBC, BMP, ESR, CRP) only if considering endogenous endophthalmitis
  • Ocular ultrasound to look for alternative diagnosis

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

References

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