Acute endophthalmitis

Acute endophthalmitis is a severe inflammatory condition affecting the interior of the eye, specifically the vitreous and/or aqueous humor. It represents a medical emergency characterized by rapid-onset infection or inflammation within the eyeball that can lead to permanent vision loss if not treated promptly. The condition is most commonly caused by bacterial or fungal organisms that gain entry to the eye, typically following intraocular surgery (particularly cataract surgery), intravitreal injections, penetrating ocular trauma, or, less frequently, through hematogenous spread from a distant infection site (endogenous endophthalmitis). Key symptoms include rapidly progressive eye pain, marked decrease in visual acuity, redness of the eye (conjunctival injection), swelling of the eyelids, hypopyon (a visible layer of white blood cells settling in the anterior chamber), and vitreous haze or opacification. Patients may also experience photophobia and excessive tearing. The onset of symptoms is typically within days of the inciting event in exogenous cases, though endogenous cases may develop more insidiously. Treatment requires urgent intervention and typically involves intravitreal injection of broad-spectrum antibiotics (such as vancomycin and ceftazidime for bacterial cases, or antifungal agents like amphotericin B or voriconazole for fungal cases). Vitreous tap or biopsy is performed to identify the causative organism through culture and sensitivity testing. In severe cases, pars plana vitrectomy surgery may be necessary to remove infected vitreous material and improve antibiotic penetration. Topical and systemic corticosteroids may be used as adjunctive therapy to reduce inflammation, though their role remains debated. Despite aggressive treatment, visual outcomes can be poor, particularly in cases caused by virulent organisms or when treatment is delayed.

Common questions about Acute endophthalmitis