Endophthalmitis

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

Clinical presentation

Loss of vision, may be associated with pain in the affected eye
Blood culture should be done to identify the source and how it can be treated (for bacteraemia)
In post injury or surgery, culture of specimens of aqueous or vitreous humour should be done

Investigations

Visual acuity
Slit lamp bimicroscopy
Tonometry
Refraction
B scan
Vitreous Tap for Gram stain, Culture and sensitivity

Pharmacological Treatment

Refer immediately to an ophthalmologist for treatment

Endogenous Endophthalmitis

Specialist initiated; vitrectomy often required

B: ceftriaxone (IV) 2g 24hourly for 7days

Adjust antibiotics according to culture and sensitivity

AND

D: ceftazidime (intravitreal) 2.25mg stat repeat after 16–24hours

AND

S: vancomycin (intravitreal) 1mg stat repeat after 72hours

Administer using separate 1 ml tuberculin or Insulin syringes

Post-Surgical endophthalmitis

Specialist initiated; vitrectomy often required

D: ceftazidime (intravitreal) 2.25mg stat repeat after 16 – 24hours

AND

D: vancomycin (intravitreal) 1mg stat repeat after 72hours

Administer using separate tuberculin or Insulin syringes

In addition, if there is soft tissue involvement or as a prophylaxis after a penetrating injury:

A: ciprofloxacin (PO) 750mg 12hourly for 7days