Endophthalmitis

What is endophthalmitis?

Endophthalmitis (pronounced en-dof-thal-my-tis) is the medical name for an infection that affects the inside of your eye. In endophthalmitis, a bacterial or fungal infection triggers inflammation, an immune system response.

Endophthalmitis affects the aqueous humor and the vitreous humor. The aqueous humor is a normally clear fluid found between your lens and cornea at the front of your eye. The vitreous humor, a clear gel, sits between your lens and retina toward the back of your eye.

Endophthalmitis is a serious medical condition that needs immediate treatment. It can spread and cause vision loss. Panophthalmitis is the name for an infection that spreads to all parts of your eyeball and extends into the orbit.

An ophthalmologist may say that you have bacterial endophthalmitis or fungal endophthalmitis. They may also name the type of endophthalmitis by indicating how you got the infection. For example:

• Exogenous endophthalmitis: This happens when something gets in your eye. You may develop exogenous endophthalmitis if you have an eye injury.
• Endogenous endophthalmitis: You may develop this type of endophthalmitis because you have a fungal or bacterial infection in another part of your body that then spreads to the eye through your blood. Endogenous endophthalmitis is less common than exogenous endophthalmitis.

What are the signs and symptoms of endophthalmitis?

Endophthalmitis signs and symptoms may include:

• Red eyes.
• Significant eye pain.
• Loss of vision.
• Sensitivity to bright light (photophobia).
• Swollen eyelids.
• Watery eyes (epiphora).

What causes endophthalmitis?

There are many causes of endophthalmitis. For example, any eye trauma, such as a tree branch hitting your eye or having eye surgery, may lead to exogenous endophthalmitis. Likewise, many infections in the body could lead to endogenous endophthalmitis, but this is usually in people who are severely ill.

What are examples of penetrating eye trauma and exogenous endophthalmitis?

Common causes of ways that bacteria and fungi can get into your eye from the outside include:

• Eye surgery: The most common eye surgery is cataract surgery, but you can also have surgery for glaucoma and other eye problems. Most people who develop postoperative endophthalmitis usually notice decreased vision and eye aches within a week or so after the procedure. Acute endophthalmitis comes on quickly after surgery. Chronic endophthalmitis takes longer to develop and may last longer.
• Injections into the eye, called intraocular or intravitreal injections: Eye care providers may treat some condition by injecting certain medications into your vitreous humor. Age-related macular degeneration is example of a condition treated with intraocular or intravitreal injections.
• Industrial or motor vehicle accidents: You can get a foreign object that penetrates your eye from an industrial or motor vehicle accident.
• Sports: You can hurt your eye while playing contact sports.

What kinds of bacterial and fungal infections cause endogenous endophthalmitis?

In Europe and North America, the most common bacteria that cause endogenous endophthalmitis are Staphylococcus aureus and Streptococcus pneumoniae. Candida albicans causes a majority of fungal infections.

Bacterial and fungal infections can spread through your body by getting into your bloodstream. Here are a few examples of these infections:

• Having dental work.
• Receiving intravenous drugs (through the vein, or IV).
• Having pneumonia or sepsis.
• Having surgical procedures anywhere inside your body.
• Having an abscess or a skin ulcer.
• Having a urinary tract infection.

Recent studies have found that some people who’ve had COVID-19 developed endogenous endophthalmitis. It’s most likely that the endophthalmitis resulted from an infection that developed in the hospital. The people most at risk seem to be people who:

• Were in the hospital for a long time.
• Have other serious medical conditions.
• Were treated with IV antibiotics and other medicines.

Is endophthalmitis contagious?

Although infectious agents cause endophthalmitis, it doesn’t spread from person to person.

How is endophthalmitis diagnosed?

An eye care provider will ask you about your health history and your current signs and symptoms. They’ll give you a complete eye exam.

They’ll take a sample of fluid or discharge from your eye to test in a laboratory. They may also want to test samples of your blood and urine.

In some cases, a provider might ask for an ultrasound of the eye (ocular ultrasound).

How is endophthalmitis treated?

An eye care provider may treat endophthalmitis with medicine. They may prescribe antibiotic or antifungal medications or corticosteroids. You may get eye drops or injections.

If the disease severely affects your vision, your provider may suggest a surgery called a vitrectomy. This procedure removes infectious material from your eye and lets the surgeon inject antibiotic or antifungal medication inside your eye.

Your provider may suggest you wear an eye patch for a time after the surgery.

Complications/side effects of the treatment

Possible complications from intravitreal injections of anti-infective drugs include damage to the cornea or the retina.

How soon after treatment will I feel better?

Your symptoms of pain and redness may begin to improve after a few days, but you may continue to have vision problems after that. It can take weeks or even months for endophthalmitis to resolve completely.

How can I reduce my risk for endophthalmitis?

Ways to reduce your risk of endophthalmitis may include:

1. Always using protective eye gear if your job involves work where an object like a piece of machinery or a tool might hit your eye. You should also wear protective eye gear if you play contact sports.
2. Making sure your hands are clean if you have to touch your eyes.
3. Following provider recommendations for self-care after surgery.

What can I expect if I have endophthalmitis?

As with many conditions, the outlook for endophthalmitis is typically better if it’s caught and treated early. Outcomes may be worse in people who have immune systems that don’t work well or have diabetes.

Some people have low vision that lasts after treatment. If this happens, speak to your healthcare team about getting support.

How do I take care of myself?

If you have endophthalmitis, you’ll need regular eye appointments. Always tell a healthcare provider about any change in vision or eye pain.

If you have vision loss after treatment, your provider can help you find support services if they’re necessary.

A note from Cleveland Clinic

If you have any type of surgery, especially eye surgery or eye injections, and you develop worrisome symptoms, contact a healthcare provider immediately. Symptoms may include eye pain, discharge or redness. Acute endophthalmitis is a medical emergency. You need treatment as soon as possible to improve your chances of recovery.