Revision 8 for 'Endophthalmitis'

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Endophthalmitis

Endophthalmitis is a potentially sight threatening condition that involves intra-ocular inflammation of any cause. Although this can  be infectious or non-infectious, in clinical practice intraocular infection reflects the most common cause. 

Clinical presentation

Eye pain and discomfort are common presenting symptoms sometimes accompanied by blurred vision. Physical examination can reveal swollen eyelids, chemosis, conjunctival injection, corneal edema, reduced red reflex, reduced visual acuity  and raised intraocular pressure. Diagnosis is frequently made clinically in most cases based on these features.

Pathology

Bacterial endophthalmitis has been classified as exogenous or endogenous depending on the cause. Exogenous causes frequently include ocular surgery, penetrating injury or spread of periocular infection (i.e. orbital cellulitis). Endogenous cases comprise only 2-7% of endophthalmitis cases and involve haematogenous seeding of intraocular infection from a primary source. 1

Radiographic features

CT

Often shows non-specific features including:

  • proptosis (due to raised intra-orbital pressure)
  • orbital fat stranding
  • thickening of the sclera
  • choroidal enhancement post-contrast
    • often in early disease
  • hyperdensity of the vitreous humor 
MRI
  • areas of high FLAIR signal in the vitreous humor
  • T1 isointensity or hyperintensity of the vitreous depending on the proteinaceous content
  • restricted diffusion on DWI
    • similar to an abscess, is virtually diagnostic of endophthalmitis
    • reducing diffusion restriction is thought to correlate with treatment response 2
  • edema within the extra-ocular tissues

Treatment and prognosis

Intravitreal antibiotics are the mainstay of treatment and vitreal aspiration can be performed to identify the causative pathogen. Severe cases may require surgery with vitrectomy and debridement.

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