Bacterial Endophthalmitis Follow-up

Updated: Jun 20, 2016
  • Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Follow-up

Further Outpatient Care

Patients should receive follow-up care on a daily basis. Clinical features indicating improvement include the following:

  • Reduced pain
  • Decreased inflammation and hypopyon
  • Increased red reflex
  • Retraction of any fibrin
  • Improved visual acuity

If no improvement occurs in 48-72 hours, consider the following:

  • Repeat tap/biopsy and antibiotic injections
  • Vitrectomy and injection of antibiotics, if no previous vitrectomy exists

If view is poor, B-scan ultrasound is useful to rule out retinal detachment.

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Further Inpatient Care

Patients may be admitted or may be treated as outpatients depending on the following:

  • Severity of endophthalmitis and treatment modalities
  • Underlying systemic diseases
  • Patient reliability and compliance
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Inpatient & Outpatient Medications

Topical antibiotic coverage with dosage dependent on severity, as follows:

  • Vancomycin 50 mg/mL 1 gtt qid to q1h
  • Ceftazidime 50 mg/mL 1 gtt qid to q1h
  • Prednisolone 1 gtt qid to q1h
  • Atropine 1 gtt bid
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Deterrence/Prevention

See the list below:

  • Identify high-risk patients before elective surgery (see below)
    • Blepharitis
    • Abnormal lacrimal drainage
    • Active infection elsewhere
  • Preparation of operative field (see below)
    • Prep with 5-10% povidone-iodine solution in preoperative area
    • Prep with 5-10% povidone-iodine immediately before draping and allow solution to dry
    • Drape to cover lashes and lid margins
  • Prophylactic topical and/or periocular antibiotics [14, 43]
  • Prophylactic intravitreal antibiotics in trauma cases
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Complications

See the list below:

  • Retinal necrosis
  • Retinal detachment (see below)
    • Retinal necrosis
    • Vitreous tap
    • Vitrectomy
  • Increased intraocular pressure
  • Retinal vascular occlusion
  • Optic neuropathy
  • Panophthalmitis
  • Hypotony (see below)
    • Ciliary body shutdown
    • Wound leakage
    • Retinal detachment
    • Cyclodialysis cleft
    • Medication
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Prognosis

The prognosis depends on the following:

  • Duration of endophthalmitis
  • Time to treatment
  • Virulence of bacteria
  • Etiology of entry
  • Existing ocular diseases

From the EVS, the percentage of patients achieving a final visual acuity of 20/100 or better were as follows:

  • Gram-positive, coagulase-negative micrococci - 84%
  • S aureus - 50% [44]
  • Streptococci - 30%
  • Enterococci - 14%
  • Gram-negative organisms - 56%

A statistically significant number (P < 0.001) of poorer visual outcomes occurred with a positive Gram stain or when bacteria other than gram-positive, coagulase-negative cocci were found. [13]

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Patient Education

Direct patients to maintain hygienic practice after surgery.

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