Figure 1. Hypopyon is an accumulation of white blood cells in the anterior chamber of the eye and corneal infiltrate associated with infectious endophthalmitis. Image courtesy of ©Retina Image Bank, contributed by Aleksandra V. Rachitskay, MD, Cole Eye Institute, Cleveland Clinic. 2014. Image 16250.
Other symptoms include
Acute cases of endophthalmitis are caused by gram-positive (or less frequently gram-negative) bacteria and are most often seen within 6 weeks after surgery or trauma to the eye.
Chronic cases that occur outside of the 6-week window are often related to a previous surgery and are commonly caused by slowly progressive infections such as Propionibacterium acnes or fungus.
Finally, systemic infections can spread to the eye causing endogenous endophthalmitis. This is often associated with systemic fungal or gram-negative bacterial infections. Patients who are debilitated, septicemic (bacteria in the bloodstream), and who have weakened immune systems are particularly susceptible, especially after surgical procedures.
Loss of vitreous gel (also referred to as vitreous humor), disrupted posterior capsule, poor wound closure, and prolonged surgery are risk factors for developing endophthalmitis. The incidence following penetrating trauma is 4–13% and may be as high as 30% after injuries in rural settings.
Risk factors for endophthalmitis after trauma include:
To determine what organism has caused the infection, a biopsy of the fluid within your eye needs to be obtained. This fluid is then sent to the laboratory for a determination and to decide on the best treatment.
Treatment and prognosis
In acute cases, treating endophthalmitis is an emergency and needs to be performed as soon as possible. The procedure performed will depend on your vision. If your vision is very poor, you will need to undergo an emergency surgery called a vitrectomy to remove the infectious debris from your eye and to inject antibiotics or antifungal agents directly inside your eye. Cases with better vision may only require an injection of antibiotics or antifungal agents in the office. In rare cases, only antibiotic eye drops are required.
The prognosis depends on the cause, duration, and type of organism that caused the infection. Outcomes are often less favorable for traumatic cases involving gram negative organisms. Some cases involving gram positive bacterial infections after cataract surgery fare better. Eyes with endophthalmitis often require frequent examinations to obtain the best outcomes.