Endogenous endophthalmitis: diagnosis, management, and prognosis

Affiliations

¹ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. ali.sdq@hotmail.com.
² Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. muhammadhassan070@gmail.com.
³ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. aniruddha9@gmail.com.
⁴ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. salman.sarwar@gmail.com.
⁵ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. shafak.toufeeq@nhs.net.
⁶ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. mhmd_soliman@hotmail.com.
⁷ Department of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt. mhmd_soliman@hotmail.com.
⁸ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. mostafa.hanout@gmail.com.
⁹ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. yasir.sepah@unmc.edu.
¹⁰ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. diana.do@unmc.edu.
¹¹ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. quan.nguyen@unmc.edu.

PMID: 26525563
PMCID: PMC4630262
DOI: 10.1186/s12348-015-0063-y

Endogenous endophthalmitis: diagnosis, management, and prognosis

Mohammad Ali Sadiq et al. J Ophthalmic Inflamm Infect. 2015 Dec.

. 2015 Dec;5(1):32.

doi: 10.1186/s12348-015-0063-y. Epub 2015 Nov 3.

Authors

Affiliations

¹ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. ali.sdq@hotmail.com.
² Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. muhammadhassan070@gmail.com.
³ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. aniruddha9@gmail.com.
⁴ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. salman.sarwar@gmail.com.
⁵ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. shafak.toufeeq@nhs.net.
⁶ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. mhmd_soliman@hotmail.com.
⁷ Department of Ophthalmology, Assiut University Hospital, Assiut University, Assiut, Egypt. mhmd_soliman@hotmail.com.
⁸ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. mostafa.hanout@gmail.com.
⁹ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. yasir.sepah@unmc.edu.
¹⁰ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. diana.do@unmc.edu.
¹¹ Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68105, USA. quan.nguyen@unmc.edu.

PMID: 26525563
PMCID: PMC4630262
DOI: 10.1186/s12348-015-0063-y

Abstract

Endogenous endophthalmitis is an ophthalmic emergency that can have severe sight-threatening complications. It is often a diagnostic challenge because it can manifest at any age and is associated with a number of underlying predisposing factors. Microorganisms associated with this condition vary along a broad spectrum. Depending upon the severity of the disease, both medical and surgical interventions may be employed. Due to rarity of the disease, there are no guidelines in literature for optimal management of these patients. In this review, treatment guidelines based on clinical data and microorganism profile have been proposed.

Keywords: Bacterial; Endogenous; Endophthalmitis; Fungal; Metastatic; Review.

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Figures

**Fig. 1**
A case of bilateral tubercular endogenous endophthalmitis with scleritis. a Slit lamp biomicroscopy of the left eye with diffuse and circumcorneal congestion and scleral involvement. There is corneal edema and opacification superiorly. The pupil has broad-based synechiae, and the view of the posterior segment was hazy. b The right eye with severe congestion and ciliary injection. There was a yellow glow present (visible near the inferior pupillary border). c A wide-angled fundus photograph of the left eye with vitreous haze secondary to vitritis along with focal sheathing of superior vessels. The fluorescein angiography (d) shows presence of superior perivascular hyperfluorescence and leakage of dye in the superotemporal periphery

**Fig. 2**
Fundus photograph of a 78-year-old male (a) with a yellow white mass in the temporal paramacular region with some superficial hemorrhages suggestive of a choroidal abscess. The patient was diagnosed with *Nocardia* endophthalmitis based on retinal aspirates (d, e). b Fundus photograph taken at 3 weeks following intravenous trimethoprim-sulfamethoxazole therapy. There was a marked resolution of the lesion and improvement in media clarity at month 3 (c). d Hematoxylin-eosin staining (×20) of the retinal aspirate. e Gram-positive branching rods of *Nocardia* species (×40)

**Fig. 3**
Ultrasound B-scan of a patient diagnosed with endogenous bacterial endophthalmitis following septic arthritis. There is presence of dense, hyper-reflective echoes in the vitreous cavity suggestive of exudates (*yellow arrow*). The membrane-like echo in the scan marked by *yellow triangles* suggests presence of a total retinal detachment

**Fig. 4**
A proposed management of patients with endogenous endophthalmitis. Signs such as poor visual acuity (≤ perception of light), large hypopyon, and choroidal abscess make the diagnosis of endophthalmitis very likely. In a neonate with white reflex, endophthalmitis (along with other considerations such as malignancy) must be kept as a possibility in the differential diagnosis. Sight-threatening lesions involving the fovea, optic nerve head, cornea, limbus, or sclera may require prompt surgical management. *APD* afferent pupillary defect, V _A visual acuity, LP light perception

See this image and copyright information in PMC

References

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Endogenous endophthalmitis: diagnosis, management, and prognosis

Affiliations

Endogenous endophthalmitis: diagnosis, management, and prognosis

Authors

Affiliations

Abstract

Figures

References

LinkOut - more resources

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