Chronic endophthalmitis

Chronic endophthalmitis is a rare, persistent inflammatory and infectious condition affecting the interior of the eye (the vitreous cavity and/or aqueous humor). Unlike acute endophthalmitis, which presents dramatically within days, chronic endophthalmitis develops insidiously over weeks to months, often following ocular surgery (most commonly cataract extraction with intraocular lens implantation), penetrating trauma, or, less frequently, through hematogenous spread from a distant infection. The condition is typically caused by low-virulence organisms, particularly Cutibacterium acnes (formerly Propionibacterium acnes), coagulase-negative staphylococci, and certain fungi such as Candida or Aspergillus species. Key symptoms include progressive, painless or mildly painful blurred vision, chronic low-grade anterior chamber inflammation (flare and cells), vitreous haze or opacities, and the formation of white plaques on the intraocular lens or within the capsular bag. Patients may experience recurrent episodes of inflammation that partially respond to topical corticosteroids but relapse upon discontinuation. Granulomatous keratic precipitates and hypopyon may also be observed. Because of its indolent course, chronic endophthalmitis is frequently misdiagnosed as chronic noninfectious uveitis, leading to significant delays in appropriate treatment. Treatment depends on the causative organism and typically involves a combination of intravitreal antibiotic or antifungal injections, and in many cases, pars plana vitrectomy with removal of the intraocular lens and capsular bag to eliminate sequestered organisms. Systemic antimicrobial therapy may also be employed. Early and accurate diagnosis through vitreous or aqueous sampling with culture and polymerase chain reaction (PCR) testing is critical for optimal outcomes. Despite treatment, visual prognosis is variable, and some patients may experience permanent vision loss due to chronic inflammation and secondary complications such as cystoid macular edema, retinal detachment, or glaucoma.

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