eMedicine Specialties > Ophthalmology > Globe

Endophthalmitis, Bacterial: Follow-up

Author: Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Contributor Information and Disclosures

Updated: Feb 12, 2009

Follow-up

Further Inpatient Care

  • Patients may be admitted or may be treated as outpatients depending on the following:
    • Severity of endophthalmitis and treatment modalities
    • Underlying systemic diseases
    • Patient reliability and compliance

Further Outpatient Care

  • Patients should receive follow-up care on a daily basis. Clinical features indicating improvement include the following:
    • Reduced pain
    • Decreased inflammation and hypopyon
    • Increased red reflex
    • Retraction of any fibrin
    • Improved visual acuity
  • If no improvement occurs in 48-72 hours, consider the following:
    • Repeat tap/biopsy and antibiotic injections
    • Vitrectomy and injection of antibiotics, if no previous vitrectomy exists
  • If view is poor, B-scan ultrasound is useful to rule out retinal detachment.

Inpatient & Outpatient Medications

  • Topical antibiotic coverage with dosage dependent on severity
    • Vancomycin 50 mg/mL 1 gtt qid to q1h
    • Ceftazidime 50 mg/mL 1 gtt qid to q1h
    • Prednisolone 1 gtt qid to q1h
    • Atropine 1 gtt bid

Deterrence/Prevention

  • Identify high-risk patients before elective surgery
    • Blepharitis
    • Abnormal lacrimal drainage
    • Active infection elsewhere
  • Preparation of operative field
    • Prep with 5-10% povidone-iodine solution in preoperative area
    • Prep with 5-10% povidone-iodine immediately before draping and allow solution to dry
    • Drape to cover lashes and lid margins
  • Prophylactic topical and/or periocular antibiotics
  • Prophylactic intravitreal antibiotics in trauma cases

Complications

  • Retinal necrosis
  • Retinal detachment
    • Retinal necrosis
    • Vitreous tap
    • Vitrectomy
  • Increased intraocular pressure
  • Retinal vascular occlusion
  • Optic neuropathy
  • Panophthalmitis
  • Hypotony
    • Ciliary body shutdown
    • Wound leakage
    • Retinal detachment
    • Cyclodialysis cleft
    • Medication

Prognosis

  • The prognosis depends on the following:
    • Duration of endophthalmitis
    • Time to treatment
    • Virulence of bacteria
    • Etiology of entry
    • Existing ocular diseases
  • From the EVS, the percentage of patients achieving a final visual acuity of 20/100 or better were as follows:
    • Gram-positive, coagulase-negative micrococci - 84%
    • S aureus - 50%
    • Streptococci - 30%
    • Enterococci - 14%
    • Gram-negative organisms - 56%
  • A statistically significant number (P <0.001) of poorer visual outcomes occurred with a positive Gram stain or when bacteria other than gram-positive, coagulase-negative cocci were found.

Patient Education

  • Direct patients to maintain hygienic practice after surgery.

Miscellaneous

Medicolegal Pitfalls

  • Medicolegal problems usually occur when the expectations of the patient are not met. If the potential for infection and the risk of loss of vision are explained clearly to the patient, the risk for legal action may be avoided. The problem most often occurs in elective surgery (eg, cataract extraction) when patients expect improved vision but end with significant loss of vision and morbidity. Document the discussions in all cases.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors, David T Wong, MD, FRCS(C), and Hesham Lakosha, MBChB, MS, FRCS, to the development and writing of this article.



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References
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Further Reading

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Keywords

bacterial endophthalmitis, bacterial infection in the eye, bacteria in the eye, bacterial eye infection, eye infection, ocular infection

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Contributor Information and Disclosures

Author

Robert H Graham, MD, Senior Associate Consultant, Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona
Robert H Graham, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Arizona Ophthalmological Society
Disclosure: WebMD/eMedicine Salary Employment

Medical Editor

Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center
Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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