Endogenous Endophthalmitis

Excerpt

Endophthalmitis, a dreaded ophthalmic emergency, is defined as the intraocular infection of the coats of the eyeball associated with diffuse vitreous inflammation. It can manifest in significant ocular and systemic complications. The mode of spread can be exogenous or endogenous. Exogenous endophthalmitis can result from trauma, post-surgery, or secondary to keratitis. In contrast, endogenous endophthalmitis, also called metastatic endophthalmitis, results from hematogenous spread of microorganisms secondary to underlying systemic pathology like diabetes, immunosuppression, renal pathology, etc. Suspected cases should undergo imaging like ultrasound B scan, aqueous and vitreous tap for culture and sensitivity, vitreous biopsy, or polymerase chain reaction whenever indicated for rapid diagnosis.

Prompt clinical diagnosis, targeted investigation, meticulous management, and regular follow-up is mandated to safeguard vision in these cases. Medical management includes topical and systemic antibiotics or antifungals, intravitreal antibiotics or antifungals, and surgical treatment of choice is pars plana vitrectomy. The collaboration of the treating ophthalmologist or vitreoretinal surgeon, microbiologists, pathologists, and the critical care physician plays a vital role in determining the patient's final systemic and ocular outcome.