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 |
|---|---|---|
| Exogenous | ||
| Trauma | Bacillus, coagulase-negative staphylococci, Pseudomonas, molds | open globe, may be fulminant with Bacillus |
| 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, gram-negative bacilli | pain and vision loss, maybe fever |
| Fungemia | Candida, Aspergillus | 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
