Ophthalmology
Endogenous Endophthalmitis
Endogenous endophthalmitis is a rare and dreaded ophthalmic emergency that usually results in vision-threatening sequelae. The diagnosis is often a challenge for all ophthalmologists and vitreoretinal surgeons and is generally secondary to underlying secondary systemic pathology. In a few cases, sometimes the cause may not be identified. It can manifest at any age and has varied predisposing risk factors. The etiology is multifactorial with a broad spectrum of microorganisms. Medical or surgical
v1 · Reviewed Nov 7, 2026 by Automated Clinical Reviewer (Strict Verbatim v1)
- Endogenous endophthalmitis is a rare and dreaded ophthalmic emergency that usually results in vision-threatening sequelae.
- Endophthalmitis, a dreaded ophthalmic emergency, is defined as the intraocular infection of the coats of the eyeball associated with diffuse vitreous inflammation.
- The infection can occur at any age with equal gender predilection.
- Neonatal EE is an alarming entity in children with bacterial infections, candida infection, malnourishment, retinopathy of prematurity, low birth weight, septicemia.
- Suspected cases should undergo imaging like ultrasound B scan, aqueous and vitreous tap for culture and sensitivity, vitreous biopsy, or polymerase chain reaction whenever indicated for rapid diagnosis.
- Prompt clinical diagnosis, targeted investigation, meticulous management, and regular follow-up is mandated to safeguard vision in these cases.
- Every case warrants a detailed slit lamp and dilated fundus evaluation.
- B Scan Ultrasound
- Optical Coherence Tomography
- Anterior Chamber and Vitreous Tap
- Polymerase Chain Reaction
- Blood Culture
- Medical management includes topical and systemic antibiotics or antifungals, intravitreal antibiotics or antifungals, and surgical treatment of choice is pars plana vitrectomy.
- Bacterial EE warrants treatment of systemic infection with antibiotics.
- Once infection EE is suspected, a sample for culture and sensitivity should be obtained, and intravitreal antibiotics should be initiated.
- Early intravitreal antibiotics should be initiated within 24 hours of presentation as they have been reported to have a better and favorable outcome.
- Before the etiology is established, broad-spectrum intravitreal antibiotics should be administered.
Vancomycin
intravitreal
- Adult
- 1mg/0.1 ml
- Renal
- Not specified in source
- Duration
- Not specified in source
Amphotericin B (AMB) deoxycholate
intravitreal
- Adult
- 5 to 10 ug/0.1 ml
- Renal
- Not specified in source
- Duration
- Not specified in source
Voriconazole
intravitreal
- Adult
- 100-200 ug/0.1 ml
- Renal
- Not specified in source
- Duration
- Not specified in source
- Vancomycin is the drug of choice for MRSA.
- The drugs commonly used for VRSA are daptomycin 200 ug/0.1 ml and quinupristin/dalfopristin 0.4 mg/0.1 ml.
- Fluoroquinolones are a broad spectrum with gram-positive and negative coverage.
- Antibiotics should be used cautiously in pregnant and lactating mothers.
- Penicillin group of drugs, cephalosporins, and erythromycin can be used safely in these patients.
- Cartilage abnormalities have been reported secondary to fluoroquinolones; hence they should not be used as the first line in pregnant women.
- The other alternative recommended by the infectious disease society of America (IDSA) is fluconazole.
- In severe cases with non-resolving vitritis, pars plana vitrectomy is the treatment of choice.
- Pars plana vitrectomy (PPV) is the treatment of choice for non-resolving vision-threatening bacterial and fungal EE cases.
- The patient should be reassessed after 48 hours, and if needed, the dose can be repeated.
- AMB has been reported to cause nephrotoxicity, hypotension, and arrhythmia.
- Hence the patient should be closely monitored for these side effects.
- The treatment duration depends on the clinical picture, but a minimum of 6 weeks is recommended.
- All patients with EE should be admitted to the hospital, and close monitoring of systemic and ocular parameters is mandated in these cases.
- Patients requiring intravitreal injections should be evaluated daily for improvement in clinical picture and need for further injections.
- In case of worsening EE, the surgeon's discretion makes a decision for pars plana vitrectomy.
- The patient should be followed up closely to assess the clinical picture and rule out any complications.
- reviewEndogenous Endophthalmitis. StatPearls [Internet] — Bharat Gurnani, Kirandeep Kaur — StatPearls Publishing, 2023
Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov