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Endophthalmitis Treatment & Management

  • Author: Daniel J Egan, MD; Chief Editor: Robert E O'Connor, MD, MPH  more...
 
Updated: Apr 06, 2015
 

Emergency Department Care

Once the diagnosis has been made, or strongly considered, prompt consultation to an ophthalmologist is needed. Treatment depends on the underlying cause of endophthalmitis. Final visual outcome is heavily dependent on timely recognition and treatment. Although multiple different approaches to and advances in treatment have been made, according to recent data, the rate of preservation of visual acuity has not changed significantly since 1995.[19]

Treatment of postoperative endophthalmitis

Pars plana vitrectomy or vitreous aspiration may be performed by an ophthalmologist with administration of intravitreal antibiotics (ie, vancomycin, amikacin, ceftazidime).

Consider systemic antibiotic administration as well as intravitreal steroids.

Patients with postoperative endophthalmitis usually are not admitted to the hospital. However, the decision to admit the patient is determined in consultation with the ophthalmologist.

Treatment of traumatic endophthalmitis

Admit the patient to the hospital.

Treat ruptured globe (if present).

Systemic antibiotics including vancomycin and an aminoglycoside or a third-generation cephalosporin are indicated. Consider clindamycin until Bacillus species can be ruled out if soil contamination is suspected.

Topical fortified antibiotics are used.

Intravitreal antibiotics should be administered.

Consider pars plana vitrectomy.

Tetanus immunization is necessary if immunization record is not current.

Cycloplegic drops (ie, atropine) may be considered.

Treatment of endogenous bacterial endophthalmitis

Admit the patient to the hospital.

Broad-spectrum intravenous antibiotics including vancomycin and an aminoglycoside or third-generation cephalosporin. Consider adding clindamycin in intravenous drug users until Bacillus infection can be ruled out.

Periocular antibiotics are sometimes indicated.

Intravitreal antibiotics are indicated.

Cycloplegic drops (ie, atropine) may be administered.

Topical steroids may be considered.

Vitrectomy may be needed for virulent organisms.

Treatment of candidal endophthalmitis

Admit the patient to the hospital.

Oral fluconazole is indicated.

Amphotericin B intravenous or intravitreal may be considered.

Cycloplegic drops (ie, atropine) may be considered.

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Consultations

Ophthalmologist: Emergent consultation is necessary if this diagnosis is entertained. This is an ophthalmologic emergency, as the patient is in danger of losing his or her vision.

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Contributor Information and Disclosures
Author

Daniel J Egan, MD Associate Attending Physician, Associate Residency Director, Department of Emergency Medicine, St Luke's Roosevelt Hospital Center; Assistant Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons

Daniel J Egan, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

David A Peak, MD Associate Residency Director of Harvard Affiliated Emergency Medicine Residency; Attending Physician, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American Medical Association

Disclosure: Partner received salary from Pfizer for employment.

Jessica Radin Peters, MD Attending Physician, Urgent Care Center, Newton-Wellesley Hospital

Jessica Radin Peters, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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.

Chief Editor

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Association for Physician Leadership, American Heart Association, Medical Society of Delaware, Society for Academic Emergency Medicine, Wilderness Medical Society, American Medical Association, National Association of EMS Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, American Medical Association

Disclosure: Nothing to disclose.

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Severe endophthalmitis. Courtesy of Ron Afshari Adelman MD, MPH, MBA, FACS, Yale Medical Group.
 
 
 
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