eMedicine Specialties > Emergency Medicine > Ophthalmology

Endophthalmitis: Differential Diagnoses & Workup

Author: Daniel J Egan, MD, Associate Attending Physician, Department of Emergency Medicine, St Luke's Roosevelt Hospital Center
Coauthor(s): Jessica Radin Peters, MD, Attending Physician, Department of Emergency Medicine, Instructor, Harvard Medical School, Brigham and Women's Hospital; David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
Contributor Information and Disclosures

Updated: Apr 23, 2009

Differential Diagnoses

Cavernous Sinus Thrombosis
Iritis and Uveitis
Corneal Abrasion
Postoperative inflammation
Corneal Laceration
Systemic Lupus Erythematosus
Corneal Ulceration and Ulcerative Keratitis
Vitreous Hemorrhage
Endocarditis
Globe Rupture
Herpes Zoster Ophthalmicus

Other Problems to Be Considered

Postsurgical inflammation
Allergic reaction
Foreign bodies
Chemical or thermal burns
Trauma
Exposure keratopathy
Retinitis
Toxocara canis infection
Large cell lymphoma
Retinoblastoma
Acute retinal necrosis
Parasitic infection

Workup

Laboratory Studies

  • The most important laboratory study for endophthalmitis is Gram stain and culture of the aqueous and vitreous obtained by the ophthalmologist.
  • For endogenous endophthalmitis, other laboratory studies that may be performed include the following:
    • Complete blood count with differential - Evaluating for signs of infection, elevated white count, left shift
    • Erythrocyte sedimentation rate - Evaluating for rheumatic causes, chronic infections, or malignancy. The ESR is often normal in cases of endophthalmitis.
    • Blood urea nitrogen - Evaluating for renal failure or patients at increased risk
    • Creatinine - Evaluating for renal failure or patients at increased risk

Imaging Studies

  • Chest x-ray - Evaluating for source of infection
  • Cardiac ultrasound - Evaluating for endocarditis as source of infection
  • CT scan/MRI of orbit - May help rule out other entities in the differential diagnosis

Other Tests

  • Blood cultures - Evaluating for source of infection
  • Urine culture - Evaluating for source of infection
  • Other cultures depending on clinical signs or symptoms
    • Cerebrospinal fluid - Evaluating for source of infection
    • Throat culture - Evaluating for source of infection
    • Stool - Evaluating for source of infection
    • Indwelling intravascular catheter tip - Evaluating for source of infection
    • A culture of the penetrating object, if available, can be a valuable resource.

Procedures

  • Ophthalmological evaluation
    • Check visual acuity
    • Examine both eyes by slit lamp biomicroscopy
    • Intraocular pressure
    • Dilated funduscopy
    • Possible ultrasonography if fundus not well visualized (This will help determine if a retained intraocular foreign body is present, the density of the vitreitis, and if the retina is attached or not.)
    • Routine cultures should include aerobic, anaerobic, and fungal cultures.

More on Endophthalmitis

Overview: Endophthalmitis
Differential Diagnoses & Workup: Endophthalmitis
Treatment & Medication: Endophthalmitis
Follow-up: Endophthalmitis
Multimedia: Endophthalmitis
References
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References

  1. Taban M, Behrens A, Newcomb RL. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol. May 2005;123(5):613-20. [Medline].

  2. Boldt HC, Pulido JS, Blodi CF, et al. Rural endophthalmitis. Ophthalmology. Dec 1989;96(12):1722-6. [Medline].

  3. Thompson JT, Parver LM, Enger CL, et al. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology. Oct 1993;100(10):1468-74. [Medline].

  4. Lundstrom M, Wejde G, Stenevi U, Thorburn W, Montan P. Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology. May 2007;114(5):866-70. [Medline].

  5. Ness T, Pelz K, Hansen LL. Endogenous endophthalmitis: microorganisms, disposition and prognosis. Acta Ophthalmol Scand. Dec 2007;85(8):852-6. [Medline].

  6. Han DP, Wisniewski SR, Wilson LA, Barza M, Vine AK, Doft BH, et al. Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol. Jul 1996;122(1):1-17. [Medline].

  7. Alfaro DV, Roth D, Liggett PE. Posttraumatic endophthalmitis. Causative organisms, treatment, and prevention. Retina. 1994;14(3):206-11. [Medline].

  8. Miller JJ, Scott IU, Flynn HW Jr, et al. Endophthalmitis caused by Bacillus species. Am J Ophthalmol. 2008;145:883-8. [Medline].

  9. Verbraeken H, Rysselaere M. Post-traumatic endophthalmitis. Eur J Ophthalmol. Jan-Mar 1994;4(1):1-5. [Medline].

  10. Gupta A, Srinivasan R, Gulnar D, Sankar K, Mahalakshmi T. Risk factors for post-traumatic endophthalmitis in patients with positive intraocular cultures. Eur J Ophthalmol. Jul-Aug 2007;17:642-7. [Medline].

  11. Ng JQ, Morlet N, Pearman JW, Constable IJ, McAllister IL, Kennedy CJ. Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report. Ophthalmology. Jul 2005;112(7):1199-206. [Medline].

  12. Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. Dec 1995;113(12):1479-96. [Medline].

  13. Albert DM, ed; Jakobiec FA. Endogenous endophthalmitis. In: Principles and Practice of Ophthalmology. Vol 5. W B Saunders Co; 1994:3120-3125.

  14. Albert DM, Jakobiec FA. Postoperative endophthalmitis. In: Principles and Practice of Ophthalmology. W B Saunders Co; 2000:2441-2462.

  15. Mandelbaum S, Forster RK. Postoperative endophthalmitis. Int Ophthalmol Clin. Summer 1987;27(2):95-106. [Medline].

  16. Michelson JB, Friedlaender MH. Endophthalmitis of drug abuse. Int Ophthalmol Clin. Summer 1987;27(2):120-6. [Medline].

  17. Okada AA, Johnson RP, Liles WC. Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology. May 1994;101(5):832-8. [Medline].

  18. Parrish CM, O'Day DM. Traumatic endophthalmitis. Int Ophthalmol Clin. 1987;27(2):112-9. [Medline].

  19. Rowsey JJ, Jensen H, Sexton DJ. Clinical diagnosis of endophthalmitis. Int Ophthalmol Clin. Summer 1987;27(2):82-8. [Medline].

  20. Uka J, Minamoto A, Shimizu R. A five-year review of patients admitted with the diagnosis of bacterial endophthalmitis. Hiroshima J Med Sci. Jun 2005;54(2):47-51. [Medline].

  21. Wilhelmus KR. The pathogenesis of endophthalmitis. Int Ophthalmol Clin. Summer 1987;27(2):74-81. [Medline].

  22. Wilson FM 2d. Causes and prevention of endophthalmitis. Int Ophthalmol Clin. Summer 1987;27(2):67-73. [Medline].

  23. Wong JS, Chan TK, Lee HM, Chee SP. Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology. Aug 2000;107(8):1483-91. [Medline].

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Further Reading

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Keywords

endophthalmitis, inflammation of ocular cavities, inflammation of vitreous humor, inflammation of aqueous humor, sterile endophthalmitis, panophthalmitis, endogenous endophthalmitis, exogenous endophthalmitis

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Contributor Information and Disclosures

Author

Daniel J Egan, MD, Associate Attending Physician, Department of Emergency Medicine, St Luke's Roosevelt Hospital Center
Daniel J Egan, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jessica Radin Peters, MD, Attending Physician, Department of Emergency Medicine, Instructor, Harvard Medical School, Brigham and Women's Hospital
Jessica Radin Peters, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

David A Peak, MD, Assistant Residency Director of Harvard Affiliated Emergency Medicine Residency, Attending Physician, Massachusetts General Hospital; Consulting Staff, Department of Hyperbaric Medicine, Massachusetts Eye and Ear Infirmary
David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Richard Lavely, MD, JD, MS, MPH, Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine
Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Douglas Lavenburg, MD, Clinical Professor, Department of Emergency Medicine, Christiana Care Health Systems
Douglas Lavenburg, MD is a member of the following medical societies: American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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