From the Guidelines
Diagnosing endophthalmitis requires a comprehensive approach combining clinical evaluation and laboratory testing, with the most critical step being the prompt identification of the causative agent through vitreous tap and microbiological analysis, as recommended by the most recent guidelines 1. The diagnostic criteria for endophthalmitis involve a combination of clinical and laboratory findings. Key symptoms include:
- Sudden vision loss
- Eye pain
- Redness
- Lid swelling
- Photophobia A thorough eye examination should look for signs such as:
- Anterior chamber inflammation
- Hypopyon (pus in the anterior chamber)
- Vitritis
- Reduced red reflex Obtaining samples for microbiological analysis is crucial, and this can be done by performing an:
- Anterior chamber tap
- Vitreous tap The vitreous sample should be sent for:
- Gram stain
- Culture and sensitivity testing
- Possibly PCR analysis B-scan ultrasonography can help identify:
- Vitreous opacities
- Retinal detachment
- Choroidal thickening when direct visualization is difficult. Considering the clinical context is essential, as:
- Post-operative endophthalmitis typically occurs within days to weeks after eye surgery
- Endogenous endophthalmitis stems from bloodstream infections Laboratory tests should include:
- Complete blood count
- Blood cultures
- Other tests to identify potential sources of infection in endogenous cases Prompt diagnosis is critical, as endophthalmitis is an ocular emergency requiring immediate treatment with intravitreal antibiotics to preserve vision, with the choice of antibiotic guided by the suspected or confirmed causative agent, as outlined in the guidelines 1.
From the Research
Diagnostic Criteria for Endophthalmitis
The diagnostic criteria for endophthalmitis include:
- Clinical evaluation, with symptoms such as visual changes, ocular pain, and inflammatory findings (e.g., hypopyon) 2
- History of ocular trauma or surgery, immunocompromised state, diabetes mellitus, and injection drug use as risk factors 2
- Slit lamp examination to detect mild inflammatory reaction in the anterior chamber 3
- Dilated fundus examination to reveal a hazy view of the optic disc and posterior retina, and presence of whitish masses 3
- Aqueous or vitreous culture performed by an ophthalmology specialist to confirm the diagnosis 2
- Imaging techniques such as computed tomography, magnetic resonance imaging, and ultrasound to suggest the disease, although they cannot exclude the diagnosis 2
- Deoxyribonucleic acid sequencing techniques to contribute to early diagnosis 3
Key Findings for Diagnosis
Key findings for diagnosis of endophthalmitis include:
- Presence of hypopyon, which is an accumulation of pus or leukocytes in the anterior chamber of the eye 2, 4
- Inflammatory reaction in the anterior chamber, which can be detected by slit lamp examination 3
- Vitreous inflammation, which can be detected by dilated fundus examination 3
- Presence of fever, which may be present in some cases of endophthalmitis 2
Importance of Early Diagnosis
Early diagnosis and prompt treatment of endophthalmitis are crucial to optimize visual outcome 3, 5, 2, 6. Delayed diagnosis and treatment can lead to severe visual impairment or even loss of the eye. Therefore, it is essential to recognize the symptoms and risk factors of endophthalmitis and to perform a thorough clinical evaluation to establish an early diagnosis.