Endophthalmitis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Inflammation (usually infectious) of the aqueous | *Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus chambers) | ||
**Staphylococcus, Streptococcus, Bacillus cereus | |||
*Frequently leads to loss of vision (ocular emergency) | *Frequently leads to loss of vision (ocular emergency) | ||
==Causes== | ==Causes== | ||
*Cataract surgery | |||
**Usually within 6 weeks | |||
*[[Globe Rupture]] | |||
**Penetrating eye trauma more at risk than blunt eye trauma | |||
*Foreign body | |||
*Extension of keratitis | |||
*Hematogenous spread/endogenous (rare) | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 20: | Line 24: | ||
##Hypopyon | ##Hypopyon | ||
##Uveitis | ##Uveitis | ||
==Work-Up== | |||
*Visual Acuity | |||
*Inspect of lid, cornea, sclera | |||
*Slit lamp exam | |||
*Intraocular pressure | |||
**After exclusion of [[Globe Rupture]] | |||
*Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis | |||
*Ultrasound to look for alternative diagnosis | |||
**After exclusion of [[Globe Rupture]] | |||
==DDx== | |||
*Sterile postoperative inflammation | |||
*[[Red Eye (Unilateral)]] | |||
*[[Corneal Abrasion and Foreign Body]] | |||
*[[Uveitis]] | |||
*[[Vitreous Hemorrhage]] | |||
==Treatment== | ==Treatment== | ||
*Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal abx) | |||
*Systemic antibiotics for endogenous endophthalmitis (rare cause) | |||
**Systemic antibiotics for other etiologies is controversial | |||
**Antibiotic prophylaxis in [[Globe Rupture]] reduces incidence of endophthalmitis to <1% | |||
==Disposition== | ==Disposition== | ||
| Line 30: | Line 53: | ||
==See Also== | ==See Also== | ||
[[Eye Algorithm (Main)]] | [[Eye Algorithm (Main)]] | ||
[[Globe Rupture]] | |||
==Source== | ==Source== | ||
Tintinalli | Tintinalli | ||
Rosen's | |||
UpToDate | |||
[[Category:Ophtho]] | [[Category:Ophtho]] | ||
Revision as of 21:40, 12 September 2013
Background
- Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus chambers)
- Staphylococcus, Streptococcus, Bacillus cereus
- Frequently leads to loss of vision (ocular emergency)
Causes
- Cataract surgery
- Usually within 6 weeks
- Globe Rupture
- Penetrating eye trauma more at risk than blunt eye trauma
- Foreign body
- Extension of keratitis
- Hematogenous spread/endogenous (rare)
Clinical Features
- Headache
- Eye pain
- Photophobia
- Vision loss
- Ocular discharge
- May also see:
- Conjunctival/scleral injection
- Chemosis
- Hypopyon
- Uveitis
Work-Up
- Visual Acuity
- Inspect of lid, cornea, sclera
- Slit lamp exam
- Intraocular pressure
- After exclusion of Globe Rupture
- Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis
- Ultrasound to look for alternative diagnosis
- After exclusion of Globe Rupture
DDx
- Sterile postoperative inflammation
- Red Eye (Unilateral)
- Corneal Abrasion and Foreign Body
- Uveitis
- Vitreous Hemorrhage
Treatment
- Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal abx)
- Systemic antibiotics for endogenous endophthalmitis (rare cause)
- Systemic antibiotics for other etiologies is controversial
- Antibiotic prophylaxis in Globe Rupture reduces incidence of endophthalmitis to <1%
Disposition
- Admit
See Also
Eye Algorithm (Main) Globe Rupture
Source
Tintinalli Rosen's UpToDate