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Endophthalmitis Caused by Gram-Negative Bacteria

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Endophthalmitis

Abstract

Endophthalmitis caused by gram-negative bacteria is less common compared to gram-positive bacteria and generally has poor visual acuity outcomes. More common gram-negative bacteria causing endophthalmitis include species of Pseudomonas, Klebsiella, Proteus, Haemophilus, and Enterobacter. Pseudomonas and Enterobacter are reportedly more common. Gram-negative endophthalmitis may present with symptoms of variable pain, redness, inflammation, and decreased visual acuity. The clinical signs include eyelid edema, conjunctival chemosis/erythema, corneal edema, hypopyon, fibrinous membrane in the anterior chamber or on intraocular lens, vitritis, and periphlebitis (Fig. 17.1).

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Acknowledgment

We acknowledge support from NIH Center Core Grant P30EY014801 (Bethesda, Maryland), Research to Prevent Blindness Unrestricted Grant (New York, New York), and the Department of Defense (DOD Grant #W81XWH-09-1-0675) (Washington, DC).

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Authors and Affiliations

  1. Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 N.W., 17th Street, Miami, Florida, 33136, USA

    Nidhi Relhan M.D. & Harry W. Flynn Jr. M.D.

Authors
  1. Nidhi Relhan M.D.
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  2. Harry W. Flynn Jr. M.D.
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Corresponding author

Correspondence to Harry W. Flynn Jr. M.D. .

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Editors and Affiliations

  1. LV Prasad Eye Institute, Hyderabad, India

    Taraprasad Das

Frequently Asked Questions

Frequently Asked Questions

  1. 1.

    What are the clinical signs that differentiate from a gram-positive cocci endophthalmitis before culture results are available?

    A: There are no known clinical signs that differentiate between endophthalmitis caused by gram-positive bacteria versus gram-negative bacteria.

    Suggested read—refer to section—Introduction for clinical presentation.

  2. 2.

    Considering a restively poor outcome, should all gram-negative endophthalmitis receive a repeat intravitreal injection?

    A: Repeat intravitreal injection should be considered on the basis of the initial response to intravitreal antibiotic and topical treatment. In cases with favorable response, topical treatment can be continued. However, in cases with worsening of features, repeat intravitreal injection or pars plana vitrectomy may be considered keeping in mind the antibiotic susceptibility results.

  3. 3.

    Does intravitreal steroid play a crucial role in gram-negative endophthalmitis?

    A: Ocular inflammatory response although important for the clearance of organisms during infection can induce damage to sensitive neurologic tissues. The ocular inflammatory response is induced by growing organisms and toxins produced (LPS, protein A) as well as by the metabolically inactive organisms. Antibiotic-induced release of cell walls or their components may therefore exacerbate intraocular inflammation during endophthalmitis treatment. Adjunctive use of corticosteroids has been shown to effectively suppress inflammation in cases of meningitis or otitis media [48, 49]. But for treatment of endophthalmitis, beneficial role of corticosteroid administration have been contradictory. Topical and subconjunctival corticosteroids are widely accepted. However, use of corticosteroids given via the systemic and intravitreal routes in the treatment of endophthalmitis remains controversial. In experimental models of bacterial endophthalmitis, concomitant administration of dexamethasone was reported to be beneficial [50,51,52,53], had no effect [54], or was detrimental [55, 56] to infection outcome. Despite these conflicting results, intravitreal steroids are frequently used as an adjunct to antibiotic therapy in endophthalmitis [57].

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Relhan, N., Flynn, H.W. (2018). Endophthalmitis Caused by Gram-Negative Bacteria. In: Das, T. (eds) Endophthalmitis . Springer, Singapore. https://doi.org/10.1007/978-981-10-5260-6_17

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  • DOI: https://doi.org/10.1007/978-981-10-5260-6_17

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