eMedicine Specialties > Emergency Medicine > Ophthalmology

Endophthalmitis: Follow-up

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

Follow-up

Transfer

  • The emergency department physician should consider transfer to another facility if ophthalmology consultation is not available at his or her institution.

Deterrence/Prevention

  • Use of appropriate protective eyewear can decrease risk of ocular trauma or globe penetration in certain circumstances.

Complications

  • Complications of endophthalmitis may include the following:
    • Impairment of vision
    • Complete loss of vision
    • Loss of eye architecture
    • Enucleation

Prognosis

  • The prognosis is extremely variable because of the variety of organisms involved. The visual acuity at the time of the diagnosis and the causative agent are most predictive of outcome.
  • The outcome of endogenous endophthalmitis is generally worse than exogenous endophthalmitis due to the profile of the organisms typically involved with this form (ie, more virulent organisms, compromised host, delay in diagnosis).
  • Patients in the traumatic subgroup, especially those caused by Bacillus infection typically have a poor visual outcome.
  • In the endophthalmitis vitrectomy study group, 74% of patients had visual recovery of 20/100 or better.12
  • The prognosis appears to also be related to the patient's underlying health conditions, with one study demonstrating worsened outcomes among diabetic patients.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider diagnosis
  • Failure to obtain emergent ophthalmology consultation
  • Failure to obtain appropriate cultures prior to initiation of treatment
 


More on Endophthalmitis

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

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  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].

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  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].

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  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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