endophthalmitis

Endophthalmitis is a potentially sight-threatening intraocular infection that primarily involves the vitreous and aqueous humor. It most often arises exogenously, following intraocular procedures such as cataract surgery or intravitreal injections, or after ocular trauma. Less commonly, it is endogenous, resulting from hematogenous spread of infection to the eye from another site.

Clinical features typically begin within days of onset, with eye pain, redness, decreased vision, photophobia, and tearing. The examination often shows conjunctival injection, corneal edema, a hypopyon, and marked vitritis. If the media is opaque, B-scan ultrasonography can detect vitreous opacities and retinal detachment. Diagnosis is clinical, supported by microbiological testing of ocular fluids. Aqueous and/or vitreous samples are cultured, and PCR may help identify fastidious organisms. Blood cultures may be obtained if endogenous endophthalmitis is suspected.

Management requires urgent ophthalmologic intervention. Initial therapy is intravitreal antibiotics, typically vancomycin to cover gram-positive organisms and a second agent such as ceftazidime (or amikacin) for gram-negative bacteria. Systemic antibiotics may be used, and pars plana vitrectomy is considered in severe cases or when vision is poor at presentation to remove infectious debris and reduce load. Treatment should be guided by culture results when available. Prevention focuses on strict aseptic technique in surgery and injections, including povidone-iodine preparation and careful postoperative care.