Endophthalmitis: Difference between revisions

Latest revision as of 21:18, 16 December 2020

Background

Eye anatomy.

Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous 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

Endophthalmitis from retained foreign body

Headache
Eye pain
Photophobia
Vision loss
Ocular discharge
May also see:
- Conjunctival/scleral injection
- Chemosis
- Hypopyon
- Uveitis

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

^Emergent diagnoses ^^Critical diagnoses

Evaluation

Inspect of lid, cornea, sclera
Slit lamp exam
Intraocular pressure
- After exclusion of Globe Rupture
Bloodwork (CBC, BMP, ESR, CRP) 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

References

Authors:

@@ Line 1: / Line 1: @@
-==Treatment==
+==Background==
-#CTX + vanco
+[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
-#admit to optho
+*Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous 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==
+[[File:Endophthalmitis_from_retained_foreign_body_2015-02-03_08-16.jpg|thumbnail|Endophthalmitis from retained foreign body]]
+*[[Headache]]
+*[[Eye pain]]
+*Photophobia
+*[[Vision loss]]
+*Ocular discharge
+*May also see:
+**Conjunctival/scleral injection
+**[[red eye|Chemosis]]
+**[[Hypopyon]]
+**[[Uveitis]]
+==Differential Diagnosis==
+{{Unilateral red eye DDX}}
+==Evaluation==
+*Inspect of lid, cornea, sclera
+*Slit lamp exam
+*[[Intraocular pressure]]
+**After exclusion of [[Globe Rupture]]
+*Bloodwork (CBC, BMP, ESR, CRP) 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
 ==See Also==
-[[Eye Algorithm (Main)]]
+*[[Eye Algorithm (Main)]]
+*[[Globe Rupture]]
-[[Category:Ophtho]]
+==References==
+<references/>
+[[Category:Ophthalmology]]
+[[Category:ID]]