Endophthalmitis

Question 1

Aetiology

Answer 1

Post operative complication - rare but sight-threatening. Usually would occur after cataract surgery but can occur after any surgery such as glaucoma, corneal, anti-VEGJ injections.

Most cases are caused by staphylococcus (+), then streptococcus (+), then gram negative, then fungi.

After cataract surgery, post operative prophylaxis with antibiotics is given to reduce risk of endophthalmitis

Most cases would occur 6 weeks post surgery

Question 2

Predisposing factors

Answer 2

Ocular surgery
- Combined surgeries
- Prolonged operation time
- Wound leakage
- Vitreous loss
- Secondary IOL implantation

Sources of globe contamination
- Patients own bacterial flora
- Open globe surgery
- Contaminated surgical instruments, drapes, dressings

Diabetes, immunocompromised, CL wear

Question 3

Symptoms

Answer 3

Pain, photophobia, redness, blurred vision

Question 4

Signs

Answer 4

Lid oedema
Conjunctival hyperaemia and chemosis
AC cells + flare, fibrinous exudate +/- hypopyon in severe cases
Corneal haze
Pupil reflex may be slow or absent
Vitritis - may obscure red reflex
IOP may be normal, high, or low

Question 5

Management

Answer 5

None
REFER SAME DAY

Question 6

Management at hospital?

Answer 6

Admission
Initiate treatment within 1 hour of diagnosis
Ultrasound
Vitrectomy, AC/vitreous tap followed by microbiology of specimen
Broad spectrum antibiotics
Intravitreal corticosteroid + oral antibiotics