Endophthalmitis occurs following 2%–7% of penetrating injuries; the incidence is higher in association with IOFBs and in rural settings. Posttraumatic endophthalmitis can progress rapidly; its clinical signs include marked inflammation featuring hypopyon, fibrin, vitreous infiltration, and corneal opacification. The risk of endophthalmitis occurring after penetrating ocular injury may be reduced by prompt wound closure and early removal of IOFBs. Use of prophylactic subconjunctival, intravenous, or intravitreal antibiotics is often recommended. Intravitreal or periocular aminoglycoside antibiotics should be avoided because of their high risk of retinal toxicity. Anterior chamber and vitreous cultures should be obtained, and if endophthalmitis is suspected, antibiotics should be injected.
Table 18-2 Symptoms and Signs of Siderosis Bulbi
Bacillus cereus, which rarely causes endophthalmitis in other settings, accounts for almost 25% of cases of posttraumatic endophthalmitis. Endophthalmitis caused by B cereus has a rapid and severe course and, once established, leads to profound vision loss and often loss of the eye. Most commonly, B cereus endophthalmitis is associated with soil-contaminated injuries, especially those involving foreign bodies. Gram-negative organisms are also frequent pathogens in posttraumatic endophthalmitis.
Treatment of posttraumatic endophthalmitis should cover the aforementioned pathogens. Because recommendations for antibiotic selection can change, ophthalmologists should consult a recent reference or an infectious disease specialist.
Jindal A, Pathengay A, Mithal K, et al. Endophthalmitis after open globe injuries: changes in microbiological spectrum and isolate susceptibility patterns over 14 years. J Ophthalmic Inflamm Infect. 2014;4(1):5.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.