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Endophthalmitis
From WikEM
Contents
Background
- Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus 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:
- Conjunctival/scleral injection
- Chemosis
- Hypopyon
- Uveitis
Differential Diagnosis
Unilateral Red Eye
- Acute angle-closure glaucoma^
- Anterior uveitis
- Caustic keratoconjunctivitis^^
- Conjunctival laceration
- Conjunctivitis
- Corneal abrasion
- Corneal erosion
- Ocular foreign body
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Globe rupture^
- Herpes zoster ophthalmicus
- Intraocular foreign body
- Inflamed pingueculum
- Inflamed Pterygium
- Keratoconjunctivitis
- Keratoconus
- Lens dislocation
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Ultraviolet keratitis
^Emergent diagnoses
^^Critical diagnoses
Evaluation
- Visual Acuity
- Inspect of lid, cornea, sclera
- Slit lamp exam
- Intraocular pressure
- After exclusion of Globe Rupture
- Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis
- Ultrasound to look for alternative diagnosis
- After exclusion of Globe Rupture
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
