Abstract
Endophthalmitis refers to bacterial or fungal infection of the vitreous and/or aqueous humors of the eye. Bacterial endophthalmitis occurs most commonly after eye surgery or penetrating ocular trauma (exogenous endophthalmitis), but may also occur from hematogenous seeding during bacteremia (endogenous endophthalmitis). The presentation is usually acute, with eye pain and decreased vision. In exogenous endophthalmitis, infection is confined to the eye. There is no fever and minimal, if any, peripheral leukocytosis. Treatment includes direct injection of antibiotics into the vitreous, and vitrectomy in more severe cases. Systemic antibiotics are indicated in endogenous endophthalmitis; their role in exogenous endophthalmitis is controversial. Visual outcome depends on the virulence of the bacterial pathogen and the speed with which treatment is given. Acute bacterial endophthalmitis is a medical emergency, because delay in treatment may result in vision loss.
Similar content being viewed by others
References and Recommended Reading
Taban M, Behrens A, Newcomb RL, et al.: Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol 2005, 123:613–620.
Mollan SP, Gao A, Lockwood A, et al.: Postcataract endophthalmitis: incidence and microbial isolates in a United Kingdom region from 1996 through 2004. J Cataract Refract Surg 2007, 33:265–268.
Mistlberger A, Ruckhofer J, Raithel E, et al.: Anterior chamber contamination during cataract surgery with intraocular lens implantation. J Cataract Refract Surg 1997, 23:1064–1069.
Endophthalmitis Vitrectomy Study Group: Results of the Endophthalmitis Vitrectomy Study: a randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol 1995, 113:1479.
Waheed S, Ritterband DC, Greenfield DS, et al.: New patterns of infecting organisms in late bleb-related endophthalmitis: a ten year review. Eye 1998, 12:910–915.
DeBry PW, Perkins TW, Heatley G, et al.: Incidence of lateonset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 2002, 120:297–300.
Soheilian M, Rafati N, Mohebbi MR, et al.: Prophylaxis of acute posttraumatic bacterial endophthalmitis: a multicenter, randomized clinical trial of intraocular antibiotic injection, report 2. Arch Ophthalmol 2007, 125:460–465.
Andreoli CM, Andreoli MT, Kloek CE, et al.: Low rate of endophthalmitis in a large series of open globe injuries. Am J Ophthalmol 2009, 147:601–608.
Jackson TL, Eykyn SJ, Graham EM, et al.: Endogenous bacterial endophthalmitis: a 17-year prospective series and review of 267 reported cases. Surv Ophthalmol 2003, 48:403–423.
Okada AA, Johnson RP, Liles WC, et al.: Endogenous bacterial endophthalmitis: report of a ten-year retrospective study. Ophthalmology 1994, 101:832–838.
Wong JS, Chan TK, Lee HM, et al.: Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology 2000, 107:1483–1496.
Binder MI, Chua J, Kaiser PK, et al.: Endogenous endophthalmitis: an 18-year review of culture-positive cases at a tertiary care center. Medicine 2003, 82:97–105.
Leibovitch I, Lai T, Raymond G, et al.: Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia. Scand J Infect Dis 2005, 37:184–189.
Ness T, Pelz K, Hansen LL: Endogenous endophthalmitis: microorganisms, disposition and prognosis. Acta Ophthalmol Scand 2007, 85:852–856.
Keyashian K, Malani PN: Endophthalmitis associated with intravenous drug use. South Med J 2007, 100:1219–1220.
Chacko E, Filtcroft I, Condon PI: Meningococcal septicemia presenting as bilateral endophthalmitis. J Cataract Refract Surg 2005, 31:432–434.
Schiedler V, Scott IU, Flynn HW, et al.: Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 2004, 137:725–731.
Yang CS, Tsai HY, Sung CS, et al.: Endogenous Klebsiella endophthalmitis associated with pyogenic liver abscess. Ophthalmology 2007, 114:876–880.
Lee HC, Chuang YC, Yu WL, et al.: Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: association with invasive syndrome in patients with community-acquired bacteremia. J Intern Med 2006, 259:606–614.
Adan A, Casaroli-Marano RP, Gris O, et al.: Pathological findings in the lens capsules and intraocular lens in chronic pseudophakic endophthalmitis: an electron microscopy study. Eye 2008, 22:113–119.
Seal D, Reischl U, Behr A, et al.: Laboratory diagnosis of endophthalmitis: comparison of microbiology and molecular methods in the European Society of Cataract and Refractive Surgeons multicenter study and susceptibility testing. J Cataract Refract Surg 2008, 34:1439–1450.
Therese KL, Anand AR, Madhavan HN: Polymerase chain reaction in the diagnosis of bacterial endophthalmitis. Br J Ophthalmol 1998, 82:1078–1082.
Hykin PG, Tobal K, McIntyre G, et al.: The diagnosis of delayed post-operative endophthalmitis by polymerase chain reaction of bacterial DNA in vitreous samples. J Med Microbiol 1994, 40:408–415.
Campochiaro PA, Lim JI: Aminoglycoside toxicity in the treatment of endophthalmitis. The Aminoglycoside Study Group. Arch Ophthalmol 1994, 112:48–53.
Doft BH, Kelsey SF, Wisniewski SR: Additional procedures after initial vitrectomy or TAP-biopsy in the Endophthalmitis Vitrectomy Study. Ophthalmology 1998, 105:707–716.
Lott MN, Fuller JJ, Hancock HA, et al.: Vitreal penetration of oral moxifloxacin in humans. Retina 2008, 28:473–476.
Fiscella RG, Lai WW, Buerk B, et al.: Aqueous and vitreous penetration of linezolid (Zyvox) after oral administration. Ophthalmology 2004, 111:1191–1195.
Clark WL, Kaiser PK, Flynn HW Jr, et al.: Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis. Ophthalmology 1999, 106:1665–1670.
Endophthalmitis Vitrectomy Study Group: Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol 1996, 122:830–846.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Durand, M.L. Bacterial endophthalmitis. Curr Infect Dis Rep 11, 283–288 (2009). https://doi.org/10.1007/s11908-009-0042-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11908-009-0042-2