Warning

Audience

  • Highland Health and Social Care Partnership
  • Primary and Secondary Care

Introduction

Endophthalmitis is an intraocular bacterial infection following intraocular surgery or intraocular injection.
Extremely rare; incidence of 1 per year in NHS Highland. Can occur any time from the day after surgery to 2 weeks after surgery (most commonly 3 to 5 days following surgery).

Symptoms

  1. Increasingly severe eye pain
  2. Increasingly marked eye redness
  3. Rapid and significant decreasing vision since the procedure.

There are many conditions that can give pain and redness, eg, post-operative iritis, but endophthalmitis is extremely unlikely without a significant drop in vision. Some patients who receive intravitreal injections have poor vision to start with, so it is worth checking with the patient what the vision was like immediately following the procedure. Also, vision following vitrectomy is often vague hand movements due to intraocular gas, which lasts for 2 weeks post-operatively; this is normal.

Signs

  1. Decreased acuity (6/24 or worse)
  2. Conjunctival redness
  3. Anterior chamber inflammation may give rise to:
    a) Visible difference between visibility of the iris and pupil between the two eyes; affected eye hazy.
    b) Hypopyon (pus level at bottom of anterior chamber: see photograph below)
    c) Poorly reactive pupil

red eye and hypopyon

Red eye and hypopyon

Management

  1. Admit to NTC Ophthalmology, Raigmore as soon as possible
  2. Intravitreal antibiotics by Ophthalmologist as soon as possible. If you state that your patient has endophthalmitis Raigmore switchboard will put you through to an Ophthalmologist (even out of hours)
  3. Ofloxacin eye drops hourly
  4. Oral Ciprofloxacin 750mg twice daily
  5. Atropine 1% eye drops, 3 times per day
  6. Analgesia

Last reviewed: 28/03/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1.1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist.

Document Id: TAM549

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