2020–2021 BCSC Basic and Clinical Science Course™
12 Retina and Vitreous
Part II: Disorders of the Retina and Vitreous
Chapter 11: Focal and Diffuse Choroidal and Retinal Inflammation
Infectious Retinal and Choroidal Inflammation
Endogenous Bacterial Endophthalmitis
Endogenous bacterial endophthalmitis results from hematogenous seeding of the eye, typically during transient bacteremia. Although decreased vision and eye pain are common symptoms, many patients do not have any constitutional symptoms. A wide range of bacteria can cause endogenous bacterial endophthalmitis. In North America, 40% of cases occur in patients with endocarditis, most typically caused by either Staphylococcus or Streptococcus species. In contrast, 60% of endogenous endophthalmitis cases in Asia occur in patients with liver abscesses caused by Klebsiella pneumoniae. Nearly one-third of cases occur in patients who have urinary tract infections, most often caused by Escherichia coli. Other cases can be associated with intravenous drug use or with procedures known to produce bacteremia, particularly placement of indwelling catheters.
Table 11-3 Treatment Options for Herpetic Retinitis Caused by Cytomegalovirus (CMV), Varicella-Zoster Virus (VZV), or Herpes Simplex Virus (HSV)
Clinical presentation can vary and depends on both the size of the inoculum and the virulence of the organism; it ranges from a focal chorioretinitis (Fig 11-16) with little vitreous inflammation to a dense panophthalmitis that obscures the view of the posterior segment. The patient should undergo systemic evaluation for the source of infection and initiate treatment with systemic antibiotics. Additionally, intravitreal injection of broad-spectrum antibiotics should be considered.
Figure 11-16 Color fundus photograph of focal endogenous bacterial endophthalmitis.
(Courtesy of Janet L. Davis, MD.)
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.