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Clinical Summary

Endophthalmitis is an infection of the globe. It is a vision-threatening medical emergency. The condition typically results from exogenous inoculation of bacteria or fungi following eye surgery or trauma. Less commonly, endogenous infection can occur and may result from the extension of a corneal infection. Patients with endophthalmitis will present with pain and decreased visual acuity. For postsurgical patients, the majority of cases will present within 1 week of the surgery.

On examination, conjunctival chemosis, hyperemia, and decreased visual acuity are noted. Some cases may present with hypopyon as sequelae of intraocular inflammation. The diagnosis of endophthalmitis is clinical.

Management and Disposition

An ophthalmologist should be consulted emergently for the management of endophthalmitis. Intravitreal antibiotics will be required. Common pathogens associated with endophthalmitis include coagulase-negative staphylococci, streptococci, and Bacillus cereus. Intravitreal vancomycin plus ceftazidime is a common antibiotic regimen. Vitrectomy may be required.

Pearls

  1. Most cases of endophthalmitis occur postoperatively within the 1st week following surgery.

  2. Trauma-associated endophthalmitis can occur after penetrating globe trauma with the likelihood of infection increasing with delayed laceration closure or retained intraocular foreign bodies.

  3. Intravitreal antibiotics administered by an ophthalmologist are required for the treatment of endophthalmitis.

FIGURE 2.50

Endophthalmitis. Severe endophthalmitis and hypopyon as a postoperative complication. (Photo contributor: Lawrence B. Stack, MD.)

FIGURE 2.51

Endophthalmitis. Severe endophthalmitis and orbital cellulitis as a complication of IV drug abuse. (Photo contributor: David Effron, MD.)

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