Review Question - QID 105373

This patient is presenting with pain and decreased vision with a hypopyon on physical exam which is concerning for endophthalmitis. Recent cataract surgery is a risk factor for this condition.

Symptoms of endophthalmitis include eye pain, vision loss, swollen eyelids, and conjunctivitis. Physical exam reveals the presence of a hypopyon, which is a layer of leukocytes in the anterior chamber. Initial management involves aspiration for culture and intravitreal antibiotics (vancomycin and ceftazidime or amikacin). Prognosis depends on the cause and severity of endophthalmitis; a good indicator of outcome is visual acuity. Risk factors for endophthalmitis include anything that penetrates the eye that could inoculate bacteria including recent surgery or penetrating trauma.

Figure/Illustration A shows an example of endophthalmitis with a hypopyon present (blue arrow).

Incorrect Answers:
Answer 1: Atopic dermatitis and eczema could be found in the history of a patient with allergic conjunctivitis which presents with itchy and watery eyes with edema. Symptoms are bilateral and worsened with allergen exposure.

Answer 2: Blunt trauma may cause a hyphema to form in the eye which would present with a collection of blood in the inferior portion of the eye in the anterior chamber.

Answer 4: Chronic steroid use is a risk factor for cataracts which presents with bilateral and progressive loss of vision (worse at night) with a cloudy lens seen on slit-lamp exam.

Answer 5: Recent viral illness presents with unilateral conjunctival injection and watery/itchy eyes with symptoms that typically spread from one eye to the other in addition to other symptoms of a viral infection such as a runny nose and cough.

Bullet Summary:
Penetrating trauma and cataract surgery are risk factors for endophthalmitis.