Endophthalmitis

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This is an infection of the ocular cavity. It is an ophthalmic emergency that can cause blindness. It may occur secondary to bacteraemia or following penetrating eye injury or surgery.

Causes

• Perioperative introduction of microbial organisms into the eye

Signs and symptoms

• Redness
• Eyelid swelling.
• Pain
• Decrease in visual acuity
• Loss of vision

Investigations

• Vitreal scraping for microscopy, culture and sensitivity

Treatment objectives

• Relieve pain
• Treat infection

Pharmacological treatment

Endogenous endophthalmitis

Ceftriaxone IV

2g once daily for 7 days

Note: Adjust antibiotics according to culture and sensitivity

PLUS

Vancomycin 1mg/0.1 mL

Administer intravitreal and repeat after 72 hours

Note:  Administer using separate tuberculin syringes  

Post-surgical endophthalmitis

Ceftazidime 2.25mg/0.1ml intravitreal

Administer intravitreal and repeat after 16-24 hours

PLUS

Vancomycin 1mg/0.1 mL

Administer intravitreal, repeat after 72hrs.

Note: Administer using separate tuberculin syringes

If there is soft tissue involvement or as a prophylaxis after a penetrating injury

ADD

Ciprofloxacin oral

750mg 12 hrly for 7days

Treatment should be specialist-initiated; vitrectomy is often required