Assessment of endophthalmitis
Endophthalmitis is an ophthalmic emergency; urgently refer all cases to an ophthalmologist so that they can obtain a vitreous sample for culture and administer intravitreal antibiotics. Delayed treatment results in loss of visionConnell, 2011.
Endophthalmitis is an inflammatory condition of the intraocular cavity (the aqueous or vitreous humour; see Diagram of the eye), usually caused by infection. It is classified as exogenous or endogenous endophthalmitis.
Exogenous endophthalmitis is a sight-threatening but uncommon complication following an intraocular procedure or surgery (eg cataract surgery, intravitreal injections for age-related macular degeneration or diabetic retinopathy) or following a penetrating eye injury (which requires pre-emptive antibiotic treatment)Connell, 2011. It is usually acute, presenting 3 to 5 days after the procedure or injury with acute onset of pain, redness, floaters, photophobia and blurred vision. The most common bacterial pathogens are staphylococci, streptococci and gram-negative bacilli. Less commonly, a chronic endophthalmitis can present 6 weeks or more following surgery, caused by organisms such as Cutibacterium acnes (formerly Propionibacterium acnes).
Endogenous endophthalmitis is the result of haematogenous spread of bacterial or fungal (including Candida and related species) infections. For a list of commonly encountered Candida and related species and, if applicable, revised species names, see Common Candida and related species, and changes to nomenclature1.Risk factors and sources include a history of injecting drugs, immune compromise, indwelling catheters, pneumonia, endocarditis and liver abscessConnell, 2011The Royal Victorian Eye and Ear Hospital (RVEEH), 2022. Presentation is often less acute than exogenous endophthalmitis, and both eyes may be affected.