emDocs - January 12, 2016 - Authors: Purcell M and Conroy M
Edited by: Koyfman A & Bright J
Pearls
- Early recognition and a high index of suspicion in patients with risk factors or altered mental status are crucial given the sequelae of delayed treatment.
- Bilateral involvement occurs in 14-25% of cases, with right eye predominance due to blood flow.
- Early involvement of ophthalmology is a must, as patients will need intravitreal antibiotics and possibly vitrectomy.
- The most common causative organism in exogenous and endogenous cases are gram positive staph and strep organisms.
- Exogenous fungal inoculations can have a prolonged latency period up to seven weeks.
- Prevention with prophylactic antibiotics is key in post-traumatic cases, especially if there is a retained foreign body.
- Risk for development is increased with the presence of intraocular foreign body following trauma.
Pitfalls
- Failing to broaden evaluation once critically ill patients are stabilized.
- Failing to ask about visual changes in critically ill patients.
- Failing to involve ophthalmology, as definitive treatment with intravitreal antibiotics, culture, and vitrectomy cannot be performed in the emergency department.
- Misdiagnosis is common as symptoms may mimic glaucoma, conjunctivitis, iritis, scleritis, anterior uveitis, orbital cellulitis, mucormycosis, cavernous sinus thrombosis, and other ocular pathology.