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  • Endophthalmitis is suppurative inflammation of layers of eye of infectious etiology which may start as purulent ant. uveitis (iridocyclitis) or purulent post. Uveitis (choroiditis)  and progresses to involve retina and vitreous.
  • ModeS of infection:
  1. Exogenous –-Following perforating injuries
  • Corneal ulcer perforation post operative infection falling intraocular operation.
  1. Endogenous or metastatic – Through blood stream from some infected focus such as caries tooth, puerperal sepsis
  • Secondary infection from surrounding structures
    1. S. aureus
    2. S. epidermidis
    3. Pseudomonas
    4. E.coli, Proteus
  • Symptoms – Severe ocular pain, redness, lacrimation, photophobia, loss of vision.
  • Signs: Lids – Red, swollen,
    1. Conjunctiva, Congestion, chemosis
    2. Cornea – ring infiltration
    3. Ant. Erior Chamber – hypopyon
    4. Pupil – Yellow reflex +ve (Amauroic reflex)
  • Amaurotic reflex seen   
  • IOP increased intitially. Later decreased due to destruction of ciliary process. 
  • Rx:
  • Topical
    a. Antibiotic                          
    b. Steroids                            
    c. Cycloplegic
  • Subconjunctival                              
    a. Inj. Amikacin
  • Intravitreal
    a. Inj. amikacin
  • Systemic
    a. Antibiotics i.v.                  
    b. Oral steroids
Late Onset Endophthalmitis
  • Intraocular infection involving the vitreous cavity after previous intra ocular surgery (more than 6 weeks).
Epidemiology and etiolgogy:
  • The usual causative organism is fungus-Candida,  the most common bacteria-P. acnes
  • May occur up to 2 or more yrs after surgery.
  • Patients have variable decreased vision with photophobia, and gradual onset of symptoms. Infection may be painless.
Important clinical signs:
  • Vitritis, with or without hypopyon, more than   6 weeks after surgery;   keratic precipitates; white plaque on intraocular lens or posterior lens capsule.
  • Postoperative inflammation.
  • Rebound inflammation after discontinuing steroids.
Diagnostic evaluation:
  • Clinical exam and USG showing vitritis and variable sclero-choroidal thickening.
Prognosis and management:
  • Intravitreal tap and injection of vancomycin (or clindamycin, 1 mg/0.1 mL) may not be curative. Patients may require vitrectomy with explantation of the IOL and capsular bay.  

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