Review Question - QID 105367

This patient is presenting with blurry vision and a hypopyon after cataract surgery which is concerning for endophthalmitis which should be treated with intravitreal vancomycin and ceftazidime.

Infectious endophthalmitis is a severe complication of cataract surgery. Patients may present up to 6 weeks following surgery with a red, painful eye, and on slit-lamp examination, a collection of pus may be seen filling the anterior chamber. The most common pathogens are gram-positive agents such as streptococcal species and staphylococcal species. Physical exam may demonstrate a hypopyon and decreased visual acuity. Management involves a vitreous tap for culture and injection of intravitreal antibiotics with appropriate combinations being vancomycin and either ceftazidime or amikacin. Vitrectomy (removal of the vitreous humor) is only indicated in refractory or severe cases.

Figure A shows a hypopyon, an accumulation of pus in the anterior chamber which is seen in endopthalmitis.

Incorrect Answers:
Answer 1: Intravitreal ceftazidime and amikacin are incorrect as the appropriate antibiotics are vancomycin and either ceftazidime or amikacin.

Answer 3: IV ceftriaxone and topical erythromycin may be appropriate management of gonnococcal conjunctivitis which presents with a purulent discharge from the eye. It would not present with blurry vision and a hypopyon.

Answer 4: IV vancomycin and amikacin are inappropriate as this combination of antibiotics must be given intravitreally.

Answer 5: IV vancomycin and piperacillin-tazobactam are an inappropriate combination of antibiotics and is an inappropriate route of administration. This is a broad-spectrum regimen that could be appropriate in septic shock.

Bullet Summary:
The treatment of endophthalmitis is intravitreal vancomycin and ceftazidime (or amikacin).