Endophthalmitis
Definition: Inflammation, usually from an infection, within the anterior and posterior segments of the eye.4
Symptoms/Signs:2,5
- Symptoms include blurry vision (93%), eye pain (75%), lid swelling (33%), and conjunctival injection (81%)
**Typically there is no fever or leukocytosis for Endophthalmitis alone**
- Anterior Segment: Inflammation of aqueous humor. Look for cell and flare +/- hypopyon4
- Posterior Segment: Vitreous inflammation (vitritis) – white plaque behind the lens that often obscures the retina with possible diminished red reflex4
Diagnosis:
- Diagnosis is made clinically by your slit lamp and fundoscopic exam
- It is supported by vitreous cultures and/or newer testing via DNA microanalysis or PCR.2,5
If etiology is unclear, a systemic evaluation is needed1
- Cultures: Blood, Urine, CSF?
- Imaging: Chest X-ray, cardiac ultrasound, CT/MRI Brain
- Labs: CBC, ESR, BUN/Creatinine
Causes:1,2,5
Exogenous (60%): Direct inoculation of bacteria into the eye
- Surgery, trauma, burns
Endogenous (20%): Hematogenous spread of a bacterial infection
- Intravenous drug use, septicemia, endocarditis, abscess, indwelling catheters
Idiopathic (20%)
Infectious Organisms:1,2
- Bacterial: The most common organisms are coagulase-negative Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus species; Gram negative organisms like Pseudomonas, Escherichia coli, and Enterococcus are observed in penetrating injuries.
- Viral: Rare; they classically cause uveitis.
- Fungal: Candida albicans (75-80% of fungal cases).
Treatment:
- Systemic antibiotics are used in the treatment of Endophthalmitis, and for better penetration, intravitreal injections are often needed as well5
- Typical treatment is with vancomycin (broad coverage for over 99% of gram-positive organisms), and Ceftazadime, which is effective against nearly 100% of gram-negative bacteria observed in Endophthalmitis3
- Second line agents: amikacin, cefazolin, cefuroxime, clindamycin3
Prognosis:2,5
- In general, the outcomes for Endophthalmitis are poor
- Endogenous Endophthalmitis generally does worse than exogenous due to the organism profile involved. Furthermore, endogenous Endophthalmitis carries with it the risk of bilateral infection in 15-25% of cases
References:
- Durand M. Bacterial endophthalmitis. Current through Nov 2016, UpToDate.com
- Egan D. Peak D. Peters J. Talavera F. Lavenburg D. O’Connor E. Lavely R. Updated April 6 2015. Emedicine.medscape.com
- Khan A, Okhravi N, Lightman S. The eye in systemic sepsis. Clinical medicine (London, England). 2002;2(5):444-448.
- Ness T, Pelz K, Hansen LL. Endogenous endophthalmitis: microorganisms, disposition and prognosis. Acta ophthalmologica Scandinavica. 2007;85(8):
- Shildkrot Y. Eliott D. Infectious Endopthalmitis. Opthalmology, 4th edition, copyright 2015, 9, 723-728, e-book ISBN: 978-1-4557-5001-6
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carmellig
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