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Endophthalmitis
Endophthalmitis is an infection of the inner cavities of the eye — the vitreous and the anterior chamber — that threatens vision within hours; it usually follows surgery or an injection (exogenous) and sometimes a bloodstream infection (endogenous), and treatment is vitreous sampling and injection of antibiotics directly into the vitreous, with immediate vitrectomy when vision is very poor.
Why it matters in the exam
The picture: 2–7 days after cataract surgery or an intravitreal injection — worsening pain, reduced vision, a red eye, lid swelling, hypopyon and vitreous haze. The commonest organism after cataract surgery is coagulase-negative Staphylococcus from the patient's own skin. After penetrating trauma — Bacillus cereus, particularly fast and destructive, sometimes with a foreign body. Around an old filtering bleb after glaucoma surgery — Streptococcus and Haemophilus, even years later. Indolent inflammation appearing months after surgery, with a white plaque in the capsule — Cutibacterium acnes.
The EVS study (after cataract surgery): when vision was light perception only — immediate vitrectomy improved outcomes; when vision was hand movements or better — tap and inject alone was equivalent. Intravenous antibiotics added no benefit in this group. The usual injection: vancomycin 1 mg and ceftazidime 2.25 mg into the vitreous. The most important prevention: povidone-iodine 5% before every operation and injection, and in Europe intracameral cefuroxime at the end of cataract surgery (ESCRS). It must be distinguished from TASS — sterile inflammation within 12–24 hours with diffuse corneal oedema.
Endogenous endophthalmitis: a patient with bacteraemia or fungaemia — Klebsiella liver abscess (mainly in East Asia), endocarditis, catheters, parenteral nutrition, drug users — sometimes in both eyes. Candida forms white "fluffy" foci in the retina and vitreous; IDSA recommends a dilated fundus examination for every patient with candidaemia in the first week. Here treatment is systemic and intravitreal together, while the source is sought and treated. The prognosis is worse than in exogenous disease.
Key points
- Infection of the vitreous and chamber; 2–7 days after surgery.
- Coagulase-negative Staphylococcus is the commonest.
- EVS: light perception only → immediate vitrectomy.
- Vancomycin 1 mg and ceftazidime 2.25 mg into the vitreous.
- Prevention: povidone-iodine 5%; intracameral cefuroxime.
Summary table
| Type | Setting | Organism | Treatment |
|---|---|---|---|
| After cataract surgery | 2–7 days | Coagulase-negative Staphylococcus | Tap and inject; vitrectomy if light perception only |
| After penetrating trauma | Possible foreign body | Bacillus cereus | Vitrectomy, foreign body removal, systemic and intravitreal antibiotics |
| Bleb-related | Years after glaucoma surgery | Streptococcus, Haemophilus | Urgent injection, bleb management |
| Chronic delayed | Months after surgery, white plaque | Cutibacterium acnes | Vitrectomy and capsule removal |
| Endogenous | Bacteraemia, catheter, diabetes | Klebsiella, Candida | Systemic and intravitreal treatment, source search |
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Sources
- Endophthalmitis Vitrectomy Study (EVS) Group, 1995 — Immediate vitrectomy and intravenous antibiotics for postoperative bacterial endophthalmitis
- ESCRS Guideline for Cataract Surgery, 2024 — Prevention and treatment of endophthalmitis
- IDSA Clinical Practice Guideline for the Management of Candidiasis, 2016 — Candida endophthalmitis
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.