Endophthalmitis: Difference between revisions
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==Background== | ==Background== | ||
*Inflammation (usually infectious) of the aqueous | [[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]] | ||
*Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous chambers) | |||
**[[Staphylococcus]], [[Streptococcus]], [[Bacillus cereus]] | |||
*Frequently leads to loss of vision (ocular emergency) | *Frequently leads to loss of vision (ocular emergency) | ||
==Causes== | ===Causes=== | ||
*Cataract surgery | |||
**Usually within 6 weeks | |||
*[[Globe Rupture]] | |||
**Penetrating eye trauma more at risk than blunt eye trauma | |||
*[[Foreign body]] | |||
*Extension of [[keratitis]] | |||
*Hematogenous spread/endogenous (rare) | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Endophthalmitis_from_retained_foreign_body_2015-02-03_08-16.jpg|thumbnail|Endophthalmitis from retained foreign body]] | |||
*[[Headache]] | |||
*[[Eye pain]] | |||
*Photophobia | |||
*[[Vision loss]] | |||
*Ocular discharge | |||
*May also see: | |||
**Conjunctival/scleral injection | |||
**[[red eye|Chemosis]] | |||
**[[Hypopyon]] | |||
**[[Uveitis]] | |||
== | ==Differential Diagnosis== | ||
{{Unilateral red eye DDX}} | |||
==Evaluation== | |||
*Inspect of lid, cornea, sclera | |||
*Slit lamp exam | |||
*[[Intraocular pressure]] | |||
**After exclusion of [[Globe Rupture]] | |||
*Bloodwork (CBC, BMP, ESR, CRP) only if considering endogenous endophthalmitis | |||
*[[Ocular ultrasound]] to look for alternative diagnosis | |||
**After exclusion of [[Globe Rupture]] | |||
==Management== | |||
*Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal [[antibiotics]]) | |||
*Systemic [[antibiotics]] for endogenous endophthalmitis (rare cause) | |||
**Systemic antibiotics for other etiologies is controversial | |||
**Antibiotic prophylaxis in [[Globe Rupture]] reduces incidence of endophthalmitis to <1% | |||
**tetanus, if indicated | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
[[Eye Algorithm (Main)]] | *[[Eye Algorithm (Main)]] | ||
*[[Globe Rupture]] | |||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Ophthalmology]] | |||
[[Category:ID]] | |||
Latest revision as of 21:18, 16 December 2020
Background
- Inflammation (usually infectious) of the deep eye structures (aqueous and vitreous chambers)
- Frequently leads to loss of vision (ocular emergency)
Causes
- Cataract surgery
- Usually within 6 weeks
- Globe Rupture
- Penetrating eye trauma more at risk than blunt eye trauma
- Foreign body
- Extension of keratitis
- Hematogenous spread/endogenous (rare)
Clinical Features
- Headache
- Eye pain
- Photophobia
- Vision loss
- Ocular discharge
- May also see:
Differential Diagnosis
Unilateral red eye
- Nontraumatic
- Acute angle-closure glaucoma^
- Anterior uveitis
- Conjunctivitis
- Corneal erosion
- Corneal ulcer^
- Endophthalmitis^
- Episcleritis
- Herpes zoster ophthalmicus
- Inflamed pinguecula
- Inflamed pterygium
- Keratoconjunctivitis
- Keratoconus
- Nontraumatic iritis
- Scleritis^
- Subconjunctival hemorrhage
- Orbital trauma
- Caustic keratoconjunctivitis^^
- Corneal abrasion, Corneal laceration
- Conjunctival hemorrhage
- Conjunctival laceration
- Globe rupture^
- Hemorrhagic chemosis
- Lens dislocation
- Ocular foreign body
- Posterior vitreous detachment
- Retinal detachment
- Retrobulbar hemorrhage
- Traumatic hyphema
- Traumatic iritis
- Traumatic mydriasis
- Traumatic optic neuropathy
- Vitreous detachment
- Vitreous hemorrhage
- Ultraviolet keratitis
^Emergent diagnoses ^^Critical diagnoses
Evaluation
- Inspect of lid, cornea, sclera
- Slit lamp exam
- Intraocular pressure
- After exclusion of Globe Rupture
- Bloodwork (CBC, BMP, ESR, CRP) only if considering endogenous endophthalmitis
- Ocular ultrasound to look for alternative diagnosis
- After exclusion of Globe Rupture
Management
- Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal antibiotics)
- Systemic antibiotics for endogenous endophthalmitis (rare cause)
- Systemic antibiotics for other etiologies is controversial
- Antibiotic prophylaxis in Globe Rupture reduces incidence of endophthalmitis to <1%
- tetanus, if indicated
Disposition
- Admit