Endophthalmitis

Question 1

What are the 3 common causes of post-operative endophthalmitis?

Answer 1

-Cataract surgery (most common)
- intravitreal injections
- patient’s own bacterial flora (e.g., skin, lids, conjunctiva).

Question 2

What organisms can cause post-operative endophthalmitis?

Answer 2

Staphylococcus, Streptococcus, Gram-negative bacteria, and fungi.

Question 3

What is the onset period for acute post-operative endophthalmitis?

Answer 3

Within the first week after surgery.

Question 4

When does chronic post-operative endophthalmitis typically onset?

Answer 4

Around six weeks post-surgery.

Question 5

Can post-operative endophthalmitis be non-infective? Give examples.

Answer 5

Yes, it can be caused by retention of foreign material (e.g., cotton fibers) or toxic substances.

Question 6

What are the main causes of post-operative endophthalmitis?

Answer 6

Post-operative procedures, injections, patient’s own bacteria (e.g., from blepharitis), and injuries.

Question 7

What is a sign of post-operative endophthalmitis related to the eyelids?

Answer 7

Lid edema (swelling).

Question 8

What conjunctival signs are associated with post-operative endophthalmitis?

Answer 8

Conjunctival chemosis (swelling) and hyperemia (redness).

Question 9

How does corneal haze present in post-operative endophthalmitis?

Answer 9

The cornea becomes cloudy due to infection or inflammation.

Question 10

What are AC cells and flare, and why are they important in post-operative endophthalmitis?

Answer 10

AC cells are white blood cells, and flare is protein leakage into the anterior chamber, both indicating intraocular inflammation.

Question 11

What is hypopyon and why is it significant in post-operative endophthalmitis?

Answer 11

Hypopyon is the accumulation of pus in the anterior chamber, signaling a severe infection.

Question 12

How is the pupil light reflex affected in post-operative endophthalmitis?

Answer 12

The pupil light reflex may become sluggish or absent due to inflammation.

Question 13

How does post-operative endophthalmitis affect intraocular pressure (IOP)?

Answer 13

IOP can be normal, raised, or low depending on the severity of the inflammation.

Question 14

What is vitritis, and how does it impact the view of the fundus in post-operative endophthalmitis?

Answer 14

Vitritis is inflammation of the vitreous body, which may eliminate the red reflex, making it difficult to view the fundus.

Question 15

What are the primary symptoms of post-operative endophthalmitis?

Answer 15

Visual loss, pain, redness, and photophobia (sensitivity to light).

Question 16

What is the first step in managing suspected post-operative endophthalmitis?

Answer 16

An A1 emergency referral to an ophthalmologist with no intervention, stressing urgency.

Question 17

What should be done after referring a patient with suspected post-operative endophthalmitis?

Answer 17

Call the ophthalmology department to inform them the patient is on the way.

Question 18

What diagnostic procedures are done in the hospital for suspected post-operative endophthalmitis?

Answer 18

Ultrasound scan, anterior chamber tap, and vitreous sample collection.

Question 19

What treatments are commonly used for post-operative endophthalmitis?

Answer 19

Antibiotics (topical, subconjunctival, intravitreal, systemic), steroids (topical, intravitreal, systemic), and vitrectomy if needed to reduce the bioburden.

Question 20

What is the prognosis for patients with post-operative endophthalmitis?

Answer 20

Poor prognosis, with 55% of patients having 6/60 vision or worse after treatment.

Question 21

List the signs of post-operative endophthalmitis.

Answer 21

Lid edema, conjunctival chemosis, hyperemia, corneal haze, AC cells and flare, hypopyon, sluggish/absent pupil light reflex, variable IOP, vitritis.

Question 22

List the symptoms of post-operative endophthalmitis.

Answer 22

Visual loss, pain, redness, photophobia.