Endophthalmitis: Difference between revisions
No edit summary |
No edit summary |
||
| Line 3: | Line 3: | ||
==Background== | ==Background== | ||
*Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus chambers) | *Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus chambers) | ||
**Staphylococcus, Streptococcus, Bacillus cereus | **[[Staphylococcus]], [[Streptococcus]], [[Bacillus cereus]] | ||
*Frequently leads to loss of vision (ocular emergency) | *Frequently leads to loss of vision (ocular emergency) | ||
| Line 11: | Line 11: | ||
*[[Globe Rupture]] | *[[Globe Rupture]] | ||
**Penetrating eye trauma more at risk than blunt eye trauma | **Penetrating eye trauma more at risk than blunt eye trauma | ||
*Foreign body | *[[Foreign body]] | ||
*Extension of keratitis | *Extension of [[keratitis]] | ||
*Hematogenous spread/endogenous (rare) | *Hematogenous spread/endogenous (rare) | ||
==Clinical Features== | ==Clinical Features== | ||
*[[Headache]] | |||
*[[Eye pain]] | |||
*Photophobia | |||
*[[Vision loss]] | |||
*Ocular discharge | |||
*May also see: | |||
**Conjunctival/scleral injection | |||
**Chemosis | |||
**Hypopyon | |||
**Uveitis | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 41: | Line 41: | ||
**After exclusion of [[Globe Rupture]] | **After exclusion of [[Globe Rupture]] | ||
*Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis | *Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis | ||
*Ultrasound to look for alternative diagnosis | *[[Ultrasound]] to look for alternative diagnosis | ||
**After exclusion of [[Globe Rupture]] | **After exclusion of [[Globe Rupture]] | ||
==Treatment== | ==Treatment== | ||
*Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal | *Emergent ophtho consult (for gram stain/culture and definitive treatment of intravitreal [[antibiotics]]) | ||
*Systemic antibiotics for endogenous endophthalmitis (rare cause) | *Systemic antibiotics for endogenous endophthalmitis (rare cause) | ||
**Systemic antibiotics for other etiologies is controversial | **Systemic antibiotics for other etiologies is controversial | ||
Revision as of 15:53, 20 May 2015
Background
- Inflammation (usually infectious) of the deep eye structures (aqueous and vitreus 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:
- Conjunctival/scleral injection
- Chemosis
- Hypopyon
- Uveitis
Differential Diagnosis
- Sterile postoperative inflammation
- Red Eye (Unilateral)
- Corneal Abrasion and Foreign Body
- Uveitis
- Vitreous Hemorrhage
Diagnosis
- Visual Acuity
- Inspect of lid, cornea, sclera
- Slit lamp exam
- Intraocular pressure
- After exclusion of Globe Rupture
- Bloodwork (CBC, ESR, ) only if considering endogenous endophthalmitis
- Ultrasound to look for alternative diagnosis
- After exclusion of Globe Rupture
Treatment
- 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
See Also
Eye Algorithm (Main) Globe Rupture