Updated: 8/9/2021

Endophthalmitis

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Questions
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Evidence
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  • Snapshot
    • A 70-year-old woman presents to the emergency department for severe eye pain. She underwent left eye cataract surgery approximately 1 week ago. Over the past few days her ocular pain has progressively worsened and her vision has deteriorated in her left eye. Ophthalmology was consulted, and noted examination findings of hypopyon and vitreous opacities. A vitreous sample is obtained and she is started on intravitreal vancomycin and ceftazidime.
  • Summary
    • Endophthalmitis is an inflammation of the intraocular fluids, usually due to bacterial or fungal infection.
  • Epidemiology
    • risk factors
      • ocular trauma
      • eye surgery
      • keratitis
        • extending into the eye
      • systemic infection
  • Etiology
    • Pathophysiology
      • ocular trauma or eye surgery
        • bacterial of fungal introduction within the eye
      • systemic infection
        • bacteria or fungus seeding into the eye
  • Presentation
    • Symptoms
      • eye pain
      • blurred vision
      • red eye
    • Physical exam
      • there may be swelling of lid (but is often normal)
      • may be conjunctival chemosis
      • hypopyon is often present
      • poor visualization of the retina due to haze or vitreous opacities
  • IMAGING
    • Ultrasound evaluation
      • should be performed if adequate view of the fundus is compromised
      • vitritis
  • Studies
    • Serum labs
      • blood culture
    • Invasive studies
      • needle aspiration
        • samples the aqueous and vitreous fluid for culture
  • Differential
    • Anterior uveitis
      • differentiating factors
        • inflammation of the anterior uveal tract (iris and ciliary body)
  • Treatment
    • Medical
      • intravitreal antibiotics
        • indication
          • first-line treatment for bacterial endophthalmitis
        • medications
          • vancomycin with ceftazidime or amikacin
      • intravitreal antifungals
        • first-line treatment for fungal endophthalmitis
    • Surgical
      • pars plana vitrectomy
        • indication
          • severe and rapidly worsening endopthalmitis
  • Prognosis
    • Vision-threatening emergency
      • visual acuity of light perception-only at presentation portends poor prognosis
  • Complications
    • Blindness
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Questions (2)

(M2.OP.14.1) A 67-year-old man presents to the emergency room with eye pain. He notes that his right eye has become progressively more painful over the past day and that his vision has been worsening. He had cataract surgery in the same eye 2 weeks ago. He has a past medical history of diabetes, hypertension, obesity, and erectile dysfunction. He is currently sexually active and engages in anal, oral, and vaginal intercourse. His temperature is 100°F (37.8°C), blood pressure is 164/104 mmHg, pulse is 85/min, respirations are 12/min, and oxygen saturation is 98% on room air. Visual acuity is 20/400 in the affected eye. Physical exam is performed as seen in Figure A. Which of the following is the most appropriate treatment for this patient?

QID: 105367
FIGURES:
1

Intravitreal ceftazidime and amikacin

3%

(1/39)

2

Intravitreal vancomycin and ceftazidime

54%

(21/39)

3

IV ceftriaxone and topical erythromycin

8%

(3/39)

4

IV vancomycin and amikacin

26%

(10/39)

5

IV vancomycin and piperacillin-tazobactam

5%

(2/39)

M 7 E

Select Answer to see Preferred Response

(M2.OP.13.7) A 77-year-old woman presents with pain and decreased vision in her right eye. She states that it started yesterday and has been rapidly worsening. Her temperature is 99.0°F (37.2°C), blood pressure is 133/81 mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is most likely to be found in this patient's history?

QID: 105373
FIGURES:
1

Atopic dermatitis

48%

(21/44)

2

Blunt trauma

0%

(0/44)

3

Cataract surgery

27%

(12/44)

4

Chronic steroid use

14%

(6/44)

5

Recent viral illness

9%

(4/44)

M 6 E

Select Answer to see Preferred Response

Evidence (4)
EXPERT COMMENTS (2)
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