Endophthalmitis

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CLINICAL DESCRIPTION

Endophthalmitis is a purulent inflammation of the intraocular fluids (vitreous and aqueous). 

ENDOGENOUS BACTERIAL ENDOPHTHALMITIS

CLINICAL DESCRIPTION

Originates from sources within the body. 

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Decreased vision, pain and tearing, purulent discharge
  • Conjunctiva injection, hypopyon, corneal oedema, vitritis, reduced fundus view secondary to vitreous inflammation.

INVESTIGATIONS

  • Vitreous tap (microscopy, culture, and sensitivity)

TREATMENT

  • The choice of agents is dependent on culture and sensitivity results
  • Empirically treat endophthalmitis with systemic antibiotics with Ceftazidime 1g 12 hourly and Vancomycin 1g every 12hrs for 2-3 weeks
  • Isolated endophthalmitis is treated with oral Ciprofloxacin 750mg 12 hourly for 7-4 days and intravitreal antibiotics as in postoperative endophthalmitis below.

POSTOPERATIVE BACTERIAL ENDOPHTHALMITIS

CLINICAL DESCRIPTION

Infectious endophthalmitis shortly after ocular surgery (24 - 48 hours).

CLINICAL FEATURES

SIGNS AND SYMPTOMS

  • Loss of vision, pain and tearing, purulent discharge and lid swelling/oedema
  • Conjunctiva injection, hypopyon, corneal edema, vitritis, reduced fundus view secondary to vitreous inflammation

INVESTIGATIONS

  • Vitreous tap (microscopy, culture, and sensitivity)

TREATMENT

  • Intravitreal antibiotics are the key to management.
  • Empirical treatment Intravitreal Injections
    • Vancomycin (1mg in 0.1ml) and Ceftazidime (2.25mg in 0.1ml) OR
    • Vancomycin (1mg in 0.1ml and Amikacin (0.4mg in 0.1ml) if penicillin allergy
  • Periocular Antibiotic Injections
    • Vancomycin 2.5 mg in 0.5 ml and Ceftazidime 100 mg in 0.5 ml OR   
    • Vancomycin 2.5 mg in 0.5 ml and Amikacin 2.5 mg in 0.5 ml OR
    • Vancomycin 2.5 mg in 0.5 ml and Gentamicin 20 mg in 0.5 ml
  • Topical treatment:
    • Ciprofloxacin/moxifloxacin/ofloxacin eye drops hourly and atropine eye drops 12 hourly
    • then add Dexamethasone eye drops 8 hourly after 2 days
    • Oral steroids: Prednisolone po 1-1.5mg/kg
    • Oral Antibiotics (Are of uncertain benefit).
      • Fluoroquinolones e.g., Ciprofloxacin 750 mg 12 hourly for 7-10 days
    • Steroids
      • Periocular steroids e.g., Dexamethasone 6 mg in 0.25 ml OR Triamcinolone 1mg should be considered if systemic steroids are contraindicated