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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