Endophthalmitis Treatment & Management

  • Author: Daniel J Egan, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Sep 19, 2011
 

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.[15]

  • 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 by 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, 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, Urgent Care Center, Newton-Wellesley Hospital

Jessica Radin Peters 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.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

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

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 College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

References

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Severe endophthalmitis. Image courtesy of Joan W. Miller, MD, and Mehran Afshari, MD, Massachusetts Eye and Ear Infirmary, Boston, Mass.
 
 
 
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