POSTOPERATIVE ENDOPHTHALMITIS

Postoperative endophthalmitis is the severe inflammation involving both the anterior and posterior segments of the eye after intraocular surgery.

Cause

  • Perioperative introduction of microbial organisms into the eye, followed by inflammation

Clinical features

  • Decreased vision, and permanent loss of vision
  • Bacterial endophthalmitis: pain, redness, lid swelling, and decreased visual acuity
  • Fungal endophthalmitis: blurred vision, pain, and decreased visual acuity

Investigations

  • Vitreal tapping for gram stain
  • Culture and sensitivity

MANAGEMENT

  • It is a medical emergency and treatment should be instituted within an hour of presentation,
    especially in severe cases
  • Refer to an ophthalmologist immediately
  • Admit patients with severe endophthalmitis and treat aggressively with topical, periocular and
    where possible intravitreal injections of:
  • Antibiotics: vancomycin or ceftriaxone
    • Atropine to relieve pain

Prevention

  • Apply povidone iodine 5% in the conjunctival sac for a minimum of 3 minutes prior to surgery and 10% povidone iodine painting of the periocular skin