Endophthalmitis: Difference between revisions
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+ | ==Background== |
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+ | *May be exogenous (from trauma, surgery, or injections) or endogenous (from chorioretinitis ± vitritis) |
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+ | {| class="wikitable" |
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+ | !Category |
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+ | !Organisms |
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+ | !Clinical Findings |
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+ | |- |
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+ | ! colspan="3" |Exogenous |
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+ | |- |
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+ | |Trauma |
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+ | |[[Bacillus]], [[coagulase-negative staphylococci]], [[Pseudomonas]], [[molds]] |
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+ | |open globe, may be fulminant with [[Bacillus]] |
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+ | |- |
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+ | |Post-cataract |
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+ | |[[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[streptococci]], [[Gram-negative bacteria]] |
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+ | |aching pain with vision loss |
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+ | |- |
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+ | |Pseudophakic (chronic post-cataract) |
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+ | |[[Cutibacterium acnes]] |
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+ | |pain, vision loss, visible plaque in lens |
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+ | |- |
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+ | |Intravitral injection |
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+ | |[[coagulase-negative staphylococci]], [[streptococci]] |
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+ | |pain and vision loss, hypopyon |
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+ | |- |
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+ | |Bleb-related |
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+ | |[[streptococci]], [[Moraxella]], [[Haemophilus influenzae]] |
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+ | |pain and vision loss, may have redness, hypopyon |
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+ | |- |
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+ | ! colspan="3" |Endogenous |
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+ | |- |
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+ | |Bacteremia |
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+ | |[[streptococci]], [[coagulase-negative staphylococci]], [[Staphylococcus aureus]], [[Bacillus]], [[gram-negative bacilli]] |
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+ | |pain and vision loss, maybe fever |
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+ | |- |
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+ | |Fungemia |
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+ | |[[Candida]], [[Aspergillus]] |
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+ | |vision loss, fluffy vitreal lesions |
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+ | |} |
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+ | ==Management== |
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+ | *Systemic and intravitreal antimicrobials directed at the pathogen |
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+ | **Ensure ocular penetration (similar to CNS penetration) |
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+ | *May require surgery or vitrectomy |
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[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
Latest revision as of 15:27, 7 April 2022
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