Endophthalmitis

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When organisms, typically bacteria, enter the eye and proliferate, endophthalmitis occurs. Typically this is after surgery, eye injections or following trauma. It is potentially sight-threatening and needs to be treated immediately. Since the advent of injected antibiotics after cataract surgery, this complication is far less common.

Symptoms
  • Progressive and often rapid loss of vision
  • Increasing photophobia (aversion to bright light)  
  • Severe pain (deep and throbbing)

If you have these symptoms following eye surgery or injections you need to see the ophthalmologist immediately.

If it is out of hours, the Emergency Department can assess you and refer to the eye doctor on call.

Signs (What the Dr sees)

The cornea (front window of the eye) may go cloudy and a hypopyon (pus) may be visible inside the front chamber of the eye. The vitreous at the back of the eye will be cloudy.

The case on the left is post cataract surgery – note the pus (hypopyon) in the front
chamber of the eye. The frequency of this complication is 1:1000 cases.  The case on the
right occurred after an intraocular injection. The frequency is similar. Both cases resolved
with appropriate treatment but there was some loss of vision.

Treatment

A small aspirate will be taken from the eye, which will be sent to the laboratory for examination. The microbiologist will be able to see which organisms are present and set up cultures so that specific antibiotic sensitivities can be evaluated.
Antibiotics will be injected into the eye, as well as being given either by mouth or intravenously. You will probably be admitted to hospital. If the vision is very poor, an operation called a vitrectomy will be performed in order to remove as much of the infected material as safely possible.

Recovery

Depends upon the type of organisms involved (some are more virulent than others), antibiotic sensitivities and the rapidity with which the infection is treated. Some organisms are very virulent and can cause irreversible damage within a few hours. If the infection is not too severe, and is brought under control quickly, there is a good chance of recovering some useful vision. You will be assessed regularly and informed of your progress.