Endophthalmitis

Endophthalmitis is inflammation within the eye. Usually, this condition is the result of infection. The most common etiology is post-operative infection (after cataract surgery). However, intraocular foreign bodies and hematologic spread are other known causes. Those who get endophthalmitis from a hematologic source usually have underlying disease, including: diabetes, HIV, end-stage renal disease, heart disease, and cancer.

Presentation will likely include the complaint of decreased visual acquity and eye pain. Other complaints include red eye and swollen eyelid. On exam most patients will have a hypopyon, decreased visual acquity, and you will be unable to visualize the retina secondary to vitreal haze.

This is a true ophthalmologic emergency and the ophthalmologist should be consulted from the emergency department. Treatment includes intraocular antibiotics, usually vancomycin and ceftazidime, and potentially intraocular or systemic steroids.

These patients need to be admitted for antibiotics and frequent eye evaluations.

Sources:

Lemley, C.A., Han, D.P. Endophthalmitis: A Review of Current Evaluation and Management. Retina 27:662-680, 2007.

Ma, O.J., et al. Emergency Medicine Manual, 6th Edition. The McGraw-Hill Companies, Inc. 2004.