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 both upon the virulence of the infecting organism and the speed with which appropriate therapy is initiated.
Bacterial endophthalmitis can be divided into five categories:
- Acute postcataract surgery
- Chronic pseudophakic
The epidemiology, clinical features, diagnosis, and treatment of bacterial endophthalmitis will be reviewed here. Fungal endophthalmitis is discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of fungal endophthalmitis" and "Treatment of endogenous endophthalmitis due to Candida species" and "Treatment of exogenous endophthalmitis due to Candida species" and "Treatment of endophthalmitis due to molds".)