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Post-traumatic Endophthalmitis

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Endophthalmitis

Abstract

Endophthalmitis as a result of ocular trauma, termed post-traumatic endophthalmitis, comprises one-fifth to one-third of all cases of endophthalmitis. Diagnosis of post-traumatic endophthalmitis can be difficult since early signs may mimic open-globe injury and its repair. The most common causes of post-traumatic endophthalmitis are coagulase-negative staphylococci and Bacillus in adults and Streptococcus in children. Risk factors for development of endophthalmitis include delayed globe closure, trauma in a rural setting, wound contamination, presence of an intraocular foreign body, and lens capsule disruption. Antibiotic prophylaxis after open-globe injury involves systemic therapy, with effective regimens including quinolones alone or vancomycin plus ceftazidime. If endophthalmitis is diagnosed clinically or if multiple risk factors are present, samples of aqueous and/or vitreous fluid should be urgently obtained and empirical treatment initiated with injection of intravitreal vancomycin and ceftazidime in nonallergic patients, often plus systemic antibiotics. Injury in a rural setting or contamination with vegetable matter should prompt consideration of antifungal therapy as well. Treatment can then be tailored based on culture or polymerase chain reaction (PCR) results and sensitivities. Surgical management generally involves intravitreal antibiotics with or without vitrectomy. Delayed treatment and the presence of retinal detachment have been associated with a poorer visual outcome. Blind eyes with fulminant infection may need enucleation; risks and benefits of implant placement must be assessed on an individual basis. Eyes with endophthalmitis generally have an extremely guarded visual prognosis. Diligent aggressive medical and surgical management is needed to attain maximal possible visual outcome.

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Authors and Affiliations

  1. Department of Ophthalmology, Rutgers New Jersey Medical School, Institute of Ophthalmology and Visual Science, Newark, NJ, USA

    Neelakshi Bhagat MD, MPH, FACS & Marco A. Zarbin MD, PhD

  2. Rutgers New Jersey Medical School, Newark, NJ, USA

    Xintong Li

Authors
  1. Neelakshi Bhagat MD, MPH, FACS
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  2. Xintong Li
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  3. Marco A. Zarbin MD, PhD
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Correspondence to Neelakshi Bhagat MD, MPH, FACS .

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Editors and Affiliations

  1. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Marlene L. Durand

  2. Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA

    Joan W. Miller

  3. Massachusetts Eye and Ear, Harvard Medical School, BOSTON, Massachusetts, USA

    Lucy H. Young

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© 2016 Springer International Publishing Switzerland

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Bhagat, N., Li, X., Zarbin, M.A. (2016). Post-traumatic Endophthalmitis. In: Durand, M., Miller, J., Young, L. (eds) Endophthalmitis. Springer, Cham. https://doi.org/10.1007/978-3-319-29231-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-29231-1_9

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  • Online ISBN: 978-3-319-29231-1

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