Endophthalmitis Workup

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

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
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Imaging Studies

  • Chest radiograph - 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
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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.
    • Vitreous culture obtained by the ophthalmologist
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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.
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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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