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Version 8 (16.02.10)
Condition
Aetiology
Endophthalmitis (post-operative) (Exogenous endophthalmitis)
History of ocular surgery e.g. cataract, corneal, glaucoma, retinal
Bacterial endophthalmitis occurs after 1.4:1,000 cataract operations
Organisms (examples only, in descending order of frequency)
- Staphylococcus epidermidis and aureus, Streptococcus sp.,
Pseudomonas sp., Proteus sp., fungi
Onset may be acute (in first week) or chronic (in first month)
Post-operative endophthalmitis may also be non-infective (retention
of foreign material, e.g. cotton fibres, or caused by toxic substances,
e.g. component of unsuitable irrigating fluid)
Predisposing
Sources of contamination
factors
- patient’s own bacterial flora (skin, lids, conjunctiva, lacrimal
apparatus)
- contaminated instruments, solutions, drapes, dressings,
gloves
- (in corneal transplants) donor cornea
Patient factors
- diabetes, immunosuppression, HIV infection
Symptoms
Acute presentation:
- visual loss
- pain
- redness
- photophobia
Chronic presentation: similar, usually milder, delayed
Signs
Acute presentation:
- lid oedema
- conjunctival chemosis and hyperaemia
- corneal haze
- cells and flare in AC; fibrinous exudate and/or hypopyon if
severe
- pupil light reflex may be sluggish or absent
IOP can be normal, low or raised
vitritis (inflammation of the vitreous) may eliminate red reflex
and preclude view of fundus
Chronic presentation: similar, usually milder, delayed
Differential
Post-operative inflammation without infection
diagnosis
Other causes of acute red eye
Vitreous haemorrhage
Management by Optometrist
NonNone
pharmacological
Pharmacological
None
A1: emergency referral to Ophthalmologist, no intervention.
Management
category
Telephone on-call Ophthalmologist
Acute bacterial endophthalmitis is a rare but severe sightthreatening complication of ocular surgery
Possible management by Ophthalmologist
Admission to hospital
Ultrasound scan
Anterior chamber/vitreous tap, or vitrectomy, followed by
microbiology of specimen
Antibiotics: topical, subconjunctival, intravitreal, systemic as
indicated
Version 8 (16.02.10)
Steroids: topical, intravitreal, systemic as indicated
Evidence base
Barry P et al (the ESCRS Endophthalmitis Study Group): Clinical
observations associated with proven and unproven cases in the
ESCRS study of prophylaxis of postoperative endophthalmitis after
cataract surgery. J Cataract Refract Surg 2009; 35(9): 1521-31
Maguire JI: Postoperative endophthalmitis: optimal management
and the role and timing of vitrectomy surgery. Eye 2008; 22: 12901300
Centre for Evidence-based Medicine Level of Evidence = 1b