Endophthalmitis is an infection inside the eye which can rapidly lead to permanent loss of vision. Consequently, it requires prompt diagnosis and aggressive treatment. Endophthalmitis can occur after any kind of eye surgery. Endophthalmitis can also occur as a result of intraocular injections or from ocular trauma. Rarely, endophthalmitis occurs as a result of infection elsewhere in the body. Most cases of endophthalmitis are caused by bacteria present on the outside of the eye on the eyelids and conjunctiva. The prognosis depends on the cause, duration, and type of organism that caused the infection. Prevention of endophthalmitis depends on pretreatment of ocular surface infections, scrupulous attention to aseptic technique during surgery, and use of antiseptics and antibiotics before and after procedures.
Endophthalmitis presents with severe pain and loss of vision. The eye may be injected, watery, swollen, and tender. Examination shows intense inflammation in the front of the eye and debris obscuring the view into the back of the eye. Ultrasound may be necessary to visualize the back of the eye.
Treatment of endophthalmitis first requires sampling of fluid from the eye to determine the cause of the infection. The fluid is sent for culture and microscopic examination. Treatment is immediately begun by injecting antibiotics into the eye. Eyedrops to treat inflammation are given frequently. In severe cases, a decision is made to proceed with immediate surgery to remove infected and inflammatory material from the eye. Otherwise, re-examination within 24 hours will determine whether the treatment is working. The results of laboratory tests will also be available to determine whether an infection is present or not. Depending on the clinical findings a decision is made whether to proceed with surgery or continue intensive medical treatment.
Although antibiotics and surgery may quickly cure the infection, severe inflammation continues for several days, and vision returns slowly. The most important factor determining the outcome of endophthalmitis, is prompt diagnosis and aggressive treatment.