Tuesday, January 12, 2016

Endophtalmitis Highlights

emDocs - January 12, 2016 - Authors: Purcell M and Conroy M
Edited by: Koyfman A & Bright J
  • 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.
  • 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.