SYMPTOMS Sudden loss of vision, Blurry vision, Photophobia, Eyelid tenderness, Eyelid swelling, Eye pain, Eye redness
SIGNS Swollen eyelid, Conjunctival injection, Corneal edema, Iritis, Hypopyon, Vitritis, Hazy retinal views, Retinal periphlebitis (may be earliest sign of a endophthalmitis)
WORK-UP Slit lamp examination, Dilated retinal exam, B-scan ultrasound (if unable to view the retina)
TREATMENT Refer to retinal specialist STAT for further evaluation and treatment
FOLLOW-UP Once endophthalmitis as well as underlying etiology is treated and resolved or stable, the patient should be monitored every 4-6 months
ADDITIONAL LAB | TESTS Additional lab testing will most likely be done by the retinal specialist but will typically include a vitreous tap and biopsy in order to determine the potential underlying etiology of the endophthalmitis as well as a CT scan of the orbit with thin 1mm cuts if suspecting a traumatic endophthalmitis due to an intraocular foreign body
ETIOLOGY Significant infiltration of inflammatory cells in the vitreous more so than the aqueous
Causes of inflammatory infiltration can be exogenous (postoperative infection, ocular trauma, etc) or endogenous (from within the body such as HIV,etc)
DIFFERENTIAL DX Lens cortex or nucleus retention, Posterior uveitis such as Behcet’s disease which can present with a hypopyon, Toxic anterior segment syndrome (vitritis will typically be absent), Intraocular lymphoma
NOTES The visual prognosis for a patient with an endophthalmitis is very poor with the visual outcome typically being LP or NLP
The most common form of endophthalmitis is acute postoperative, although the risk is still extremely low
Typically postoperative endophthalmitis occurs within 3-5 days of the procedure but can also occur weeks to months later
Early diagnosis and treatment is key!
Endophthalmitis: B-scan ultrasound of an endophthalmitis https://www.highlandretina.com/our-services/conditions-we-treat/intraocular-infections-endophthalmitis