Endophthalmitis: Experience from a Tertiary Eye Care Center

Endophthalmitis is a devastating ocular inflammatory process that can lead to blindness. In endophthalmitis, there is inflammation of the vitreous cavity along with the retinal and uveal components of the eye. [1] In the vast majority of cases of endophthalmitis, inflamma‐ tion is triggered by an infectious agent. [1, 2] The source of such infectious agent could be an exogenous such as following trauma or after an eye surgery (Figures 1 & 2). Eye surgeries may be either intraocular (such as cataract, glaucoma, retina) or extra-ocular such as refrac‐ tive or muscle surgery. Post-operative endophthalmitis could be either sterile or infectious. The infectious agent encountered following the eye surgery or trauma is usually the organ‐ isms harboring the outer surface of the eye. [2, 3] Bacterial infections are the most common cause of post-operative endophthalmitis, and Gram-positive isolates account for the majori‐ ty of these cases. [2] Fungal infections may occur, particularly in association with the use of contaminated ocular irrigation fluids. [4, 5] Patients having previous history of glaucoma surgery with thin blebs and penetrating keratoplasty may also be vulnerable to risks of de‐ veloping endophthalmitis. Endogenous endophthalmitis is less common and occur secon‐ dary to hematogenous dissemination and spread from a distant infective source in the body. [2, 3, 6, 7] In patients with endogenous endophthalmitis, some of the predisposing risk fac‐ tors may include diabetes, cardiac disease, and malignancy. [2, 3] The common foci of infec‐ tion may be urinary tract infection, septic arthritis, pneumonia, and endocarditis. Less common causes of endogenous endophthalmitis include orbital and periorbital cellulitis and in rare cases facial cellulitis. [8] Recently, endophthalmitis was a major reason for eviscera‐ tion among the 187 cases reported from a tertiary eye care center. [9]