Endophthalmitis: Difference between revisions
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==Background== | ==Background== | ||
*Inflammation (usually infectious) of the deep eye structures (aqueous and | *Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous chambers) | ||
**[[Staphylococcus]], [[Streptococcus]], [[Bacillus cereus]] | **[[Staphylococcus]], [[Streptococcus]], [[Bacillus cereus]] | ||
*Frequently leads to loss of vision (ocular emergency) | *Frequently leads to loss of vision (ocular emergency) | ||
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*May also see: | *May also see: | ||
**Conjunctival/scleral injection | **Conjunctival/scleral injection | ||
**Chemosis | **[[red eye|Chemosis]] | ||
**Hypopyon | **[[Hypopyon]] | ||
**Uveitis | **[[Uveitis]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Inspect of lid, cornea, sclera | *Inspect of lid, cornea, sclera | ||
*Slit lamp exam | *Slit lamp exam | ||
*Intraocular pressure | *[[Intraocular pressure]] | ||
**After exclusion of [[Globe Rupture]] | **After exclusion of [[Globe Rupture]] | ||
*Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis | *Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis | ||
*[[ | *[[Ocular ultrasound]] to look for alternative diagnosis | ||
**After exclusion of [[Globe Rupture]] | **After exclusion of [[Globe Rupture]] | ||
==Management== | ==Management== | ||
*Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal [[antibiotics]]) | *Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal [[antibiotics]]) | ||
*Systemic antibiotics for endogenous endophthalmitis (rare cause) | *Systemic [[antibiotics]] for endogenous endophthalmitis (rare cause) | ||
**Systemic antibiotics for other etiologies is controversial | **Systemic antibiotics for other etiologies is controversial | ||
**Antibiotic prophylaxis in [[Globe Rupture]] reduces incidence of endophthalmitis to <1% | **Antibiotic prophylaxis in [[Globe Rupture]] reduces incidence of endophthalmitis to <1% | ||
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<references/> | <references/> | ||
[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
[[Category:ID]] | |||
Revision as of 16:38, 5 October 2019
Background
- Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous chambers)
- 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:
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Inspect of lid, cornea, sclera
- Slit lamp exam
- Intraocular pressure
- After exclusion of Globe Rupture
- Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis
- Ocular ultrasound to look for alternative diagnosis
- After exclusion of Globe Rupture
Management
- Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal antibiotics)
- 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%
- tetanus, if indicated
Disposition
- Admit