EM Resident - By David Traficante and Anthony Catapano - On 05/26/2016
"Emergency physicians are faced with the task of identifying life-, limb-, and eyesight-threatening diseases on a daily basis. Some of these conditions are more common and obvious than others. Endophthalmitis, although rare, is a vision-threatening disease that cannot be missed. It is an inflammatory condition involving the intraocular cavities of the eye (ie, the aqueous and/or vitreous humors) and is usually caused by infection.
Emergency Department Management
Endophthalmitis is an ophthalmological emergency and treatment is best left in the hands of an ophthalmologist.The mainstay of treatment for all types of endophthalmitis is intravitreal antibiotics +/- vitrectomy.9 For traumatic endophthalmitis, there is some evidence that systemic antibiotics are also indicated.10 For endogenous endophthalmitis, systemic antibiotic treatment is certainly indicated and should be targeted at treating the underlying source of the bacteremia. Fluconazole must be added if there is suspicion for candidal endophthalmitis.Regardless, the best and most efficient action in treating these patients is to involve ophthalmology early on in their care.
Conclusion
Delayed diagnosis of endophthalmitis can be catastrophic, and emergency medicine providers must have a low threshold for consulting ophthalmology as soon as the diagnosis is considered. While the excitement of “eye pain” may pale in comparison to the hustle and bustle that surrounds myocardial infarctions, gunshot wounds, and strokes, the consequences of missing this disease can be just as grave, and the diagnosis just as rewarding."