Endophthalmitis

Background

• Infectious of the vitreous or aqueous humour
• May be exogenous (from trauma, surgery, or injections) or endogenous (from chorioretinitis ± vitritis)

Category	Organisms	Clinical Findings
Trauma	Bacillus, coagulase-negative staphylococci, Pseudomonas, molds	open globe, may be fulminant with Bacillus
Surgical
Post-cataract	coagulase-negative staphylococci, Staphylococcus aureus, streptococci, Gram-negative bacteria	aching pain with vision loss
Pseudophakic (chronic post-cataract)	Cutibacterium acnes	pain, vision loss, visible plaque in lens
Intravitral injection	coagulase-negative staphylococci, streptococci	pain and vision loss, hypopyon
Bleb-related	streptococci, Moraxella, Haemophilus influenzae	pain and vision loss, may have redness, hypopyon
Endogenous
Bacteremia	streptococci, coagulase-negative staphylococci, Staphylococcus aureus, Bacillus	pain and vision loss, maybe fever
Fungemia	Candida, Aspergillus species	vision loss, fluffy vitreal lesions

Risk Factors

• Surgery or trauma
• Diabetes mellitus
• Injection drug use

Clinical Manifestations

• Blurry vision, redness, often pain
• Occasionally swollen lid
• Often has a hypopyon

Differential Diagnosis

• Occult retention of lens cortex or nucleus
• Uveitis
  • Non-infectious hypopyon uveitis (Behçet disease or rifabutin)
  • Posterior uveitis
    • Infectious: syphilis, tuberculosis, toxoplasmosis, or toxocariasis in children)
    • Non-infectious: Vogt-Koyanagi-Harada disease, collagen vascular disorders, systemic vasculitides, or idiopathic)
• Inflammatory reaction to intravitreal drug
• Blebitis
• Acute retinal necrosis
• Keratitis
• Intraocular lymphoma

Management

• Systemic and intravitreal antimicrobials directed at the pathogen
  • Ensure ocular penetration (similar to CNS penetration)
• May require surgery or vitrectomy