Postoperative Endophthalmitis

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Postoperative endophthalmitis is the severe inflammation involving both the anterior and posterior segments of the eye after intraocular surgery.

Cause

• Perioperative introduction of microbial organisms into the eye, followed by inflammation

Clinical features

• Decreased vision, and permanent loss of vision
• Bacterial endophthalmitis: pain, redness, lid swelling, and decreased visual acuity
• Fungal endophthalmitis: blurred vision, pain, and decreased visual acuity

Investigations

• Vitreal tapping for gram stain
• Culture and sensitivity

ManagementTreatment

• It is a medical emergency and treatment should be instituted within an hour of presentation, especially in severe cases
• Refer to an ophthalmologist immediately
• Admit patients with severe endophthalmitis and treat aggressively with topical, periocular and where possible intravitreal injections of:
• Antibiotics: vancomycin or ceftriaxone
  • Atropine to relieve pain

Prevention

• Apply povidone iodine 5% in the conjunctival sac for a minimum of 3 minutes prior to surgery and 10% povidone iodine painting of the periocular skin