What is Endophthalmitis?

Endophthalmitis is an infection of the tissues or fluids inside the eyeball. It is an urgent medical emergency. Although it’s rare, endophthalmitis can cause permanent vision loss if it’s not treated quickly.

What Are the Symptoms of Endophthalmitis?

The most common symptoms of endophthalmitis are:

  • eye pain that keeps getting worse after surgery, an injection or injury to the eye
  • red eyes
  • white or yellow pus or discharge from the eyes
  • swollen or puffy eyelids
  • decreased, blurred or lost vision

Eye injections and cataract surgery are two of the most frequent eye procedures in the United States and both can cause endophthalmitis. Even though endophthalmitis isn’t a common condition, if you have any of these symptoms and you’ve recently had cataract surgery or an eye injection, contact your ophthalmologist right away. Endophthalmitis can get worse very quickly.

What Causes Endophthalmitis?

Endophthalmitis is usually caused when bacteria gets inside the eye from surgery like cataract surgery, an injection into the eyeball or an eye injury. Puncture wounds to the eye are the most likely cause of endophthalmitis. This is called exogenous endophthalmitis, because the source of the infection comes from outside the body.

Symptoms usually begin within a few days of the eye procedure or injury. This quick onset is called acute endophthalmitis. However, the condition can also develop more slowly, called chronic endophthalmitis, if certain types of bacteria or fungi enter the eye. Acute and chronic endophthalmitis are different kinds of exogenous infection.

Less commonly, endophthalmitis can start from an infection in another part of the body, like a urinary tract or blood infection, that spreads to the eye. This kind of endophthalmitis is called endogenous endophthalmitis, meaning it comes from somewhere else inside the body.

How Serious is Endophthalmitis?

Endophthalmitis is usually a very serious problem. You should be seen as soon as possible by an ophthalmologist to be diagnosed and start treatment. If endophthalmitis isn’t treated quickly, the bacteria causing the infection can ultimately destroy the retina and eye tissues. Endophthalmitis can blind you.

How Is Endophthalmitis Diagnosed and Treated?

Your ophthalmologist will perform several tests to determine whether your symptoms are from endophthalmitis. They will look at your eye and test your vision. They will also ask about any recent surgeries, eye procedures or injuries.

If an infection is suspected, your doctor will perform a test called an aqueous/vitreous tap. This test involves using a tiny needle to take some fluid out of your eyeball. The fluid is then sent to a laboratory to test whether there is an infection.

This testing also helps your doctor decide on the best treatment. If you’ve had an eye injury, your doctor may also order an ultrasound to see if there are any foreign objects in the eye.

The first line of treatment for endophthalmitis is an injection of antibiotics or anti-fungal agents into the eye. Your ophthalmologist may also give you a steroid to reduce swelling and inflammation caused by the infection. In more advanced cases, vitrectomy surgerymay be needed to remove inflammatory debris from inside the eye. For vitrectomy, some or all of the vitreous gel inside the eye is removed and replaced with saline (salt water solution) or a gas or oil bubble.

Can Endophthalmitis Be Prevented?
  • Avoid eye injuries by using protective eyewear when doing anything that could cause an object to fly into your eye, such as sawing wood.
  • Protect your eyes with the right eyewear and safety gear during contact sports.
  • If you have eye surgery or an eye injection, follow your doctor’s aftercare instructions, including washing your hands carefully before putting in eye drops. Don’t let the eyedrop bottle touch the eye, which can contaminate the dropper.