From the Guidelines
Endophthalmitis can occur through several routes, with the most common being exogenous spread following eye surgery, trauma, or intravitreal injections, as supported by the most recent study 1 from 2024. The routes of endophthalmitis include:
- Exogenous spread following eye surgery, with organisms entering through surgical wounds
- Post-traumatic endophthalmitis, which develops when pathogens enter through penetrating injuries
- Endogenous endophthalmitis, which occurs when pathogens spread through the bloodstream from distant infection sites, particularly in immunocompromised patients or those with bacteremia or fungemia
- Intravitreal injections, which represent another significant route, with contamination occurring during the procedure
- Contaminated ophthalmic solutions or contact lenses, which can also introduce pathogens The clinical presentation varies by route but typically includes decreased vision, eye pain, redness, and hypopyon. Treatment depends on the route and severity but generally includes intravitreal antibiotics, with vitrectomy considered for severe cases, as recommended by the study 1. Understanding these routes is crucial for prevention strategies, including:
- Proper surgical technique
- Aseptic procedures during injections
- Prompt treatment of penetrating injuries
- Management of systemic infections in at-risk patients It is also important to address moderate to severe blepharitis with topical antibiotics and eyelid hygiene prior to an intraocular surgical procedure, as suggested by the study 1. The study 1 from 2016 provides additional information on the treatment of Candida endophthalmitis, but the most recent study 1 takes priority in guiding clinical practice. Similarly, the study 1 from 2008 provides information on the treatment of Aspergillus endophthalmitis, but its recommendations are not as relevant to the current clinical practice as those from the more recent study 1.
From the Research
Endophthalmitis Route
- Endophthalmitis is a serious, potentially vision-threatening condition that can occur after ocular surgeries, intravitreal injection, trauma, and systemic infection 2.
- The most common presentation of endophthalmitis is postoperative endophthalmitis after cataract surgery 2, 3.
- The condition can be caused by the entry of infective bacteria, such as staphylococcus, gram-negative organisms, and streptococcus species, as well as fungi like aspergillus and candida 3.
- Risk factors for the development of endophthalmitis following cataract surgery include patient age, intraoperative surgical complications, and poor wound construction 4.
Routes of Endophthalmitis
- Exogenous endophthalmitis: caused by external factors, such as bacterial or fungal contamination during surgery 3.
- Endogenous endophthalmitis: caused by internal factors, such as systemic infection 3.
- Postoperative endophthalmitis: occurs after cataract surgery, and can be caused by bacterial or fungal contamination during surgery 2, 3, 4, 5.
Prevention and Treatment
- Intracameral antibiotics, such as cefuroxime, moxifloxacin, and vancomycin, can be used to prevent postoperative endophthalmitis 6, 5.
- Prompt recognition and treatment of endophthalmitis are key in maximizing outcomes 2.
- Treatment of endophthalmitis typically involves intravitreal antibiotic administration, and may require pars plana vitrectomy in severe cases 2.