Endophthalmitis

Abstract

Endophthalmitis is a rare but severe form of ocular inflammation due to infection of the intraocular cavity that can lead to irreversible visual loss if not treated properly and timely. It can be classified as exogenous or endogenous based on the transmission route of the infectious source. Exogenous endophthalmitis occurs when infecting organisms gain entry into the eye via direct inoculation, while endogenous endophthalmitis occurs when infectious agents hematogenously spread into the eye from a distant focus of infection. The diagnosis of endophthalmitis depends mostly on the clinical findings on ophthalmological examination. Delayed diagnosis of endogenous endophthalmitis can lead to not only visual loss, but also increased risk of mortality. Since ocular and systemic symptoms of endophthalmitis are usually non-specific, early diagnosis relies on the alertness of clinicians. Early diagnosis and proper treatment are keys to saving the eye. Following advances in vitreoretinal pharmacotherapy and surgical technology, early surgical intervention is the current trend in the management of endophthalmitis.

Keywords: Endogenous; Endophthalmitis; Exogenous.

Fig. 1. (A) A 70-year-old female with diabetes developed endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess. Clinical presentation included typical papillary hypopyon. (B) A 75-year-old diabetic male visited an ophthalmologist before the diagnosis of KP liver abscess. Clinical examination revealed severe panophthalmitis without history of ocular trauma or surgery. The eye was lost despite treatment with systemic and intravitreal antibiotics. (C) A 63-year-old male with hypertension and history of endocarditis and liver abscess treated elsewhere 3 months prior. Ocular examination showed hypopyon, lens opacity, and vitreous opacity. Inf lammation resolved after combined pars plana vitrectomy, extracapsular cataract extraction, and administration of intravitreal antibiotics. (D) A 45-year-old male with poorly controlled diabetes developed bilateral endophthalmitis secondary to KP liver abscess. Endophthalmitis resolved after systemic antibiotics and one treatment with intravitreal ceftazidime.

Fig. 2. (A) A case of severe exogenous fungal endophthalmitis secondary to eyeball rupture post repair. (B) A typical case of acute postoperative endophthalmitis after phacoemulsification. (C) A case of chronic bleb-related endophthalmitis.