Chronic postoperative endophthalmitis is difficult to diagnose and may require invasive diagnostic testing, antibiotic or antifungal injection, and, in many cases, explantation of an intraocular lens (IOL).
Suspicion of endogenous endophthalmitis is required in immunosuppressed patients and in patients with a recent history of surgery or hospitalization or of intravenous drug abuse. The diagnosis is often definitively established by cultures and stains from vitreous aspirate obtained by diagnostic vitrectomy.
Endogenous endophthalmitis requires evaluation for a systemic source of infection, intravitreal antibiotic or antifungal injection, and often systemic antibiotics.
Endophthalmitis is a clinical diagnosis made when intraocular inflammation involving both the posterior and anterior chambers is attributable to bacterial or fungal infection. The retina or the choroid may be involved; occasionally there is concomitant infectious scleritis or keratitis. Acute postoperative and posttraumatic endophthalmitis are covered in BCSC Section 12, Retina and Vitreous, and are not discussed here. Chronic postoperative (infectious) endophthalmitis occurs weeks or months after surgery (usually cataract extraction) and can be caused by a myriad of bacteria and fungi. Endogenous endophthalmitis occurs when bacteria or fungi are hematogenously disseminated into the ocular circulation. “Sterile endophthalmitis” describes cases in which infection is suspected but that return negative culture results.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.