- Marlene L Durand, MD
Marlene L Durand, MD
- Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
Endophthalmitis refers to bacterial or fungal infection within the eye, including involvement of the vitreous and/or aqueous humors. It is not caused by viruses or parasites; by convention, infections due to these organisms are included in the term "uveitis" (eg, cytomegalovirus [CMV] retinitis, toxoplasma chorioretinitis). Most cases of endophthalmitis are exogenous, resulting from inoculation of organisms from the outside, via trauma, eye surgery, or as an extension of keratitis (corneal infection). In such cases, the aqueous humor may be seeded first before extension into the vitreous. The remaining cases are endogenous, resulting from bacteremic or fungemic seeding of the eye. In endogenous endophthalmitis, organisms usually seed the highly vascular choroid first then extend anteriorly into the vitreous.
Most cases of endophthalmitis are due to bacteria and present acutely. Acute bacterial endophthalmitis is a vision-threatening condition and must be managed as an emergency. The clinical outcome depends upon both the virulence of the infecting organism and the speed with which appropriate therapy is initiated.
Bacterial endophthalmitis can be divided into six categories:
●Acute postcataract surgery
- Javitt JC, Vitale S, Canner JK, et al. National outcomes of cataract extraction. Endophthalmitis following inpatient surgery. Arch Ophthalmol 1991; 109:1085.
- Kattan HM, Flynn HW Jr, Pflugfelder SC, et al. Nosocomial endophthalmitis survey. Current incidence of infection after intraocular surgery. Ophthalmology 1991; 98:227.
- Aaberg TM Jr, Flynn HW Jr, Schiffman J, Newton J. Nosocomial acute-onset postoperative endophthalmitis survey. A 10-year review of incidence and outcomes. Ophthalmology 1998; 105:1004.
- Lundström M, Wejde G, Stenevi U, et al. Endophthalmitis after cataract surgery: a nationwide prospective study evaluating incidence in relation to incision type and location. Ophthalmology 2007; 114:866.
- Mandelbaum S, Forster RK. Exogenous endophthalmitis. In: Ocular Immunology and Infection, Pepose JS, Holland GN, Wilhelmus KR (Eds), Mosby, St. Louis 1996. p.1298.
- Dickey JB, Thompson KD, Jay WM. Anterior chamber aspirate cultures after uncomplicated cataract surgery. Am J Ophthalmol 1991; 112:278.
- Sherwood DR, Rich WJ, Jacob JS, et al. Bacterial contamination of intraocular and extraocular fluids during extracapsular cataract extraction. Eye (Lond) 1989; 3 ( Pt 3):308.
- Tervo T, Ljungberg P, Kautiainen T, et al. Prospective evaluation of external ocular microbial growth and aqueous humor contamination during cataract surgery. J Cataract Refract Surg 1999; 25:65.
- Menikoff JA, Speaker MG, Marmor M, Raskin EM. A case-control study of risk factors for postoperative endophthalmitis. Ophthalmology 1991; 98:1761.
- Montan PG, Koranyi G, Setterquist HE, et al. Endophthalmitis after cataract surgery: risk factors relating to technique and events of the operation and patient history: a retrospective case-control study. Ophthalmology 1998; 105:2171.
- Bainbridge JW, Teimory M, Tabandeh H, et al. Intraocular lens implants and risk of endophthalmitis. Br J Ophthalmol 1998; 82:1312.
- Driebe WT Jr, Mandelbaum S, Forster RK, et al. Pseudophakic endophthalmitis. Diagnosis and management. Ophthalmology 1986; 93:442.
- Cooper BA, Holekamp NM, Bohigian G, Thompson PA. Case-control study of endophthalmitis after cataract surgery comparing scleral tunnel and clear corneal wounds. Am J Ophthalmol 2003; 136:300.
- Nagaki Y, Hayasaka S, Kadoi C, et al. Bacterial endophthalmitis after small-incision cataract surgery. effect of incision placement and intraocular lens type. J Cataract Refract Surg 2003; 29:20.
- Taban M, Behrens A, Newcomb RL, et al. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol 2005; 123:613.
- Lalwani GA, Flynn HW Jr, Scott IU, et al. Acute-onset endophthalmitis after clear corneal cataract surgery (1996-2005). Clinical features, causative organisms, and visual acuity outcomes. Ophthalmology 2008; 115:473.
- Behrens A, Stark WJ, Pratzer KA, McDonnell PJ. Dynamics of small-incision clear cornea wounds after phacoemulsification surgery using optical coherence tomography in the early postoperative period. J Refract Surg 2008; 24:46.
- Taban M, Sarayba MA, Ignacio TS, et al. Ingress of India ink into the anterior chamber through sutureless clear corneal cataract wounds. Arch Ophthalmol 2005; 123:643.
- Results of the Endophthalmitis Vitrectomy Study. A randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Endophthalmitis Vitrectomy Study Group. Arch Ophthalmol 1995; 113:1479.
- Therese KL, Anand AR, Madhavan HN. Polymerase chain reaction in the diagnosis of bacterial endophthalmitis. Br J Ophthalmol 1998; 82:1078.
- Seal D, Reischl U, Behr A, et al. Laboratory diagnosis of endophthalmitis: comparison of microbiology and molecular methods in the European Society of Cataract & Refractive Surgeons multicenter study and susceptibility testing. J Cataract Refract Surg 2008; 34:1439.
- Speaker MG, Milch FA, Shah MK, et al. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 1991; 98:639.
- Han DP, Wisniewski SR, Wilson LA, et al. Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol 1996; 122:1.
- Doft BH, Kelsey SF, Wisniewski SR. Additional procedures after the initial vitrectomy or tap-biopsy in the Endophthalmitis Vitrectomy Study. Ophthalmology 1998; 105:707.
- Ng JQ, Morlet N, Pearman JW, et al. Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report. Ophthalmology 2005; 112:1199.
- Hooper CY, Lightman SL, Pacheco P, et al. Adjunctive antibiotics in the treatment of acute bacterial endophthalmitis following cataract surgery. Acta Ophthalmol 2012; 90:e572.
- Lott MN, Fuller JJ, Hancock HA, et al. Vitreal penetration of oral moxifloxacin in humans. Retina 2008; 28:473.
- Fiscella RG, Lai WW, Buerk B, et al. Aqueous and vitreous penetration of linezolid (Zyvox) after oral administration. Ophthalmology 2004; 111:1191.
- Piest KL, Kincaid MC, Tetz MR, et al. Localized endophthalmitis: a newly described cause of the so-called toxic lens syndrome. J Cataract Refract Surg 1987; 13:498.
- Adán A, Casaroli-Marano RP, Gris O, et al. Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis: an electron microscopy study. Eye (Lond) 2008; 22:113.
- Winward KE, Pflugfelder SC, Flynn HW Jr, et al. Postoperative Propionibacterium endophthalmitis. Treatment strategies and long-term results. Ophthalmology 1993; 100:447.
- Clark WL, Kaiser PK, Flynn HW Jr, et al. Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis. Ophthalmology 1999; 106:1665.
- Aldave AJ, Stein JD, Deramo VA, et al. Treatment strategies for postoperative Propionibacterium acnes endophthalmitis. Ophthalmology 1999; 106:2395.
- Day S, Acquah K, Mruthyunjaya P, et al. Ocular complications after anti-vascular endothelial growth factor therapy in Medicare patients with age-related macular degeneration. Am J Ophthalmol 2011; 152:266.
- McCannel CA. Meta-analysis of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents: causative organisms and possible prevention strategies. Retina 2011; 31:654.
- Doshi RR, Leng T, Fung AE. Reducing oral flora contamination of intravitreal injections with face mask or silence. Retina 2012; 32:473.
- Dossarps D, Bron AM, Koehrer P, et al. Endophthalmitis After Intravitreal Injections: Incidence, Presentation, Management, and Visual Outcome. Am J Ophthalmol 2015; 160:17.
- Waheed S, Ritterband DC, Greenfield DS, et al. New patterns of infecting organisms in late bleb-related endophthalmitis: a ten year review. Eye (Lond) 1998; 12 ( Pt 6):910.
- Greenfield DS, Suñer IJ, Miller MP, et al. Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol 1996; 114:943.
- Kim EA, Law SK, Coleman AL, et al. Long-Term Bleb-Related Infections After Trabeculectomy: Incidence, Risk Factors, and Influence of Bleb Revision. Am J Ophthalmol 2015; 159:1082.
- DeBry PW, Perkins TW, Heatley G, et al. Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 2002; 120:297.
- Ciulla TA, Beck AD, Topping TM, Baker AS. Blebitis, early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery. Ophthalmology 1997; 104:986.
- Kangas TA, Greenfield DS, Flynn HW Jr, et al. Delayed-onset endophthalmitis associated with conjunctival filtering blebs. Ophthalmology 1997; 104:746.
- Soheilian M, Rafati N, Mohebbi MR, et al. Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2. Arch Ophthalmol 2007; 125:460.
- Sabaci G, Bayer A, Mutlu FM, et al. Endophthalmitis after deadly-weapon-related open-globe injuries: risk factors, value of prophylactic antibiotics, and visual outcomes. Am J Ophthalmol 2002; 133:62.
- Thompson JT, Parver LM, Enger CL, et al. Infectious endophthalmitis after penetrating injuries with retained intraocular foreign bodies. National Eye Trauma System. Ophthalmology 1993; 100:1468.
- Thompson WS, Rubsamen PE, Flynn HW Jr, et al. Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes. Ophthalmology 1995; 102:1696.
- Jonas JB, Budde WM. Early versus late removal of retained intraocular foreign bodies. Retina 1999; 19:193.
- Miller JJ, Scott IU, Flynn HW Jr, et al. Endophthalmitis caused by Bacillus species. Am J Ophthalmol 2008; 145:883.
- Abu el-Asrar AM, al-Amro SA, al-Mosallam AA, al-Obeidan S. Post-traumatic endophthalmitis: causative organisms and visual outcome. Eur J Ophthalmol 1999; 9:21.
- Alfaro DV, Roth DB, Laughlin RM, et al. Paediatric post-traumatic endophthalmitis. Br J Ophthalmol 1995; 79:888.
- Andreoli CM, Andreoli MT, Kloek CE, et al. Low rate of endophthalmitis in a large series of open globe injuries. Am J Ophthalmol 2009; 147:601.
- Okada AA, Johnson RP, Liles WC, et al. Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. Ophthalmology 1994; 101:832.
- Wong JS, Chan TK, Lee HM, Chee SP. Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology 2000; 107:1483.
- Binder MI, Chua J, Kaiser PK, et al. Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. Medicine (Baltimore) 2003; 82:97.
- Jackson TL, Eykyn SJ, Graham EM, Stanford MR. Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 2003; 48:403.
- ACUTE POSTCATARACT ENDOPHTHALMITIS
- Risk factors
- Symptoms and signs
- Differential diagnosis
- Laboratory findings
- - Intravitreal antibiotics
- - Vitrectomy
- - Adjunctive systemic antibiotics
- - Approach to therapy
- Visual outcome
- CHRONIC PSEUDOPHAKIC ENDOPHTHALMITIS
- POST-INTRAVITREAL INJECTION ENDOPHTHALMITIS
- BLEB-RELATED ENDOPHTHALMITIS
- POSTTRAUMATIC ENDOPHTHALMITIS
- ENDOGENOUS BACTERIAL ENDOPHTHALMITIS
- FUNGAL ENDOPHTHALMITIS
- SUMMARY AND RECOMMENDATIONS
- Acute postcataract endophthalmitis
- Chronic pseudophakic endophthalmitis
- Post-intravitreal injection endophthalmitis
- Bleb-related endophthalmitis
- Posttraumatic endophthalmitis
- Endogenous endophthalmitis