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Emergency: requires immediate attention
Endophthalmitis - External and Internal Eye
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Emergency: requires immediate attention

Endophthalmitis - External and Internal Eye

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Contributors: Rachel Ellis MD, Andrew Goodfriend MD, Lauren Patty Daskivich MD, MSHS, Brandon D. Ayres MD, Christopher Rapuano MD, Harvey A. Brown MD, Sunir J. Garg MD
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Synopsis

Endophthalmitis is a rare but dangerous eye infection that often leads to blindness. It is an infection that causes widespread inflammation and damage to many layers within the eye. 

Patients most at risk for endophthalmitis are those who have had previous eye trauma or surgery. Fungal endophthalmitis is most commonly found following severe eye trauma or severe corneal ulcer infections. There has been concern in recent years of an increased incidence of endophthalmitis, ranging from 0.1% to 0.18%, that appears to be associated with clear corneal nonsutured temporal incision cataract surgery. Rupture of the posterior lens capsule during cataract surgery is associated with an increased risk of endophthalmitis. The patient's external eyelid skin and lashes provide the major sources of infection during intraocular surgery. 

Endogenous endophthalmitis occurs when microorganisms cross the blood-ocular barrier and multiply within the eye. An immunocompromised state, endocarditis, and other systemic infections increase one's risk of endogenous endophthalmitis. Many patients with endogenous bacterial endophthalmitis have prolonged courses of disease due to initial misdiagnosis. Visual outcomes are typically poor, often resulting in blindness of the affected eye.  

Patients typically present acutely with pain and loss of vision. With more subacute or chronic infections, blurred vision can be the presenting symptom, or the patient can be asymptomatic. 

The critical sign on eye examination is that there is inflammation in the vitreous. Often there will be a poor view of the fundus due to vitreous inflammation. There may also be a hypopyon in the anterior chamber, which can be a collection of pus and/or inflammatory cells. 

Codes

ICD10CM:
H44.19 – Other endophthalmitis

SNOMEDCT:
1847009 – Endophthalmitis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 11/16/2016
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Emergency: requires immediate attention
Endophthalmitis - External and Internal Eye
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Endophthalmitis : Vision loss, Hypopyon, Ocular pain, Elevated intraocular pressure
Clinical image of Endophthalmitis
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