What Is Endophthalmitis?

Medically reviewed by Ann Marie Griff, OD on September 22, 2017Written by Brenda McBean, BSP, MSc on September 22, 2017

Overview

Endophthalmitis, pronounced “end-opf-THAL-mi-tis, is the term used to describe severe inflammation inside the eye. Inflammation is caused by an infection. It may occur with certain types of eye surgery or if the eye has been pierced by an outside object.

Endophthalmitis is very rare, but if it occurs, it’s an urgent medical emergency.

Symptoms of endophthalmitis

Symptoms occur very quickly after infection. They will typically occur within one to two days, or sometimes up to six days after surgery or trauma to the eye. Symptoms include:

  • eye pain that becomes worse after surgery or injury to the eye
  • decreased or loss of vision
  • red eyes
  • pus from the eye
  • swollen eyelids

Symptoms may also occur later, such as six weeks after surgery. These symptoms tend to be milder and include:

  • blurred vision
  • mild eye pain
  • trouble looking at bright lights

If you notice any of these symptoms, see a doctor right away. The sooner endophthalmitis is treated, the less likely it is to cause continued and serious vision problems.

Causes of endophthalmitis

There are two main types of endophthalmitis. One is exogenous endophthalmitis, meaning infection goes inside the eye through an outside source. The second is endogenous endophthalmitis, meaning infection spreads to the eye from another part of the body.

Exogenous endophthalmitis is the most common form. It can occur as a result of a cut to the eye during surgery or by piercing of the eye by a foreign body. Such cuts or openings make it more likely infection will travel inside the eyeball.

Exogenous endophthalmitis is seen more frequently with specific eye surgeries. One is cataract surgery. This isn’t necessarily due to the surgical procedure itself. Cataract surgery is the most common eye surgery performed, so there are more possibilities for this surgery to result in endophthalmitis.

Other surgeries that result more frequently in this type of infection are those done within the eyeball itself. This is called intraocular surgery.

Risk factors for exogenous endophthalmitis include extra loss of fluid behind the eye, poor wound healing, and a longer surgery time.

After a piercing eye trauma, risk factors for endophthalmitis include:

  • having the foreign object, or a piece of the object, remain in your eye
  • waiting more than 24 hours to repair the cut
  • being in rural settings, where you’re more likely to get soil in your eye
  • damage to the lens

People who’ve had certain types of surgery for glaucoma, such as glaucoma filtering, are at life-long risk of developing endophthalmitis.

Diagnosis

Your doctor, usually an ophthalmologist (a doctor specializing in eye health), will likely do several things to find out if symptoms are from endophthalmitis. They will look at your eye and test your vision. They may order an ultrasound to see if there are any foreign objects in the eyeball.

If an infection is suspected, your doctor may perform a test called a vitreous tap. This involves using a tiny needle to take some fluid out of your eyeball. The fluid is then tested so your doctor can tell the best way to treat the infection.

Treatment of endophthalmitis

Treatment of endophthalmitis depends in part on the cause of the condition.

It’s most important to get an antibiotic into the eye as soon as possible. Typically, antibiotics are placed right into the eye with a tiny needle. A corticosteroid may be added in some cases to reduce swelling. Only in very rare and more serious cases are general antibiotics given.

If there’s a foreign body in the eye, it’s equally important to remove the object as quickly as possible. Never try to remove an object from your eye by yourself. Instead, seek immediate medical attention.

Symptoms often begin to improve within several days of starting treatment. Eye pain and swollen eyelids tend to improve before vision gets better.

Complications from treatment

Complications from endophthalmitis treatment can be reduced by following your doctor’s eye care advice. In particular, be sure you know how and when to put in any prescribed eye drops or antibiotic eye ointment. If an eye patch is prescribed, you should also know how and where to place the patch. You may need tape to keep the patch in place.

Be sure to keep all follow-up eye appointments with your doctor.

Prevention of endophthalmitis

Use protective eyewear when doing anything that could cause an object to fly into your eye, such as sawing wood, or during contact sports. Protective eyewear may include:

  • goggles
  • eye shields
  • helmets

If you have eye surgery, follow your doctor’s postoperative instructions. That can help reduce your risk for infection.

Outlook

Endophthalmitis is a complex condition with a potentially serious outcome for your vision. Declining vision and possibly the loss of an eye may occur. The likelihood of these events is greatly reduced if the condition is treated right away. It’s a medical emergency that requires immediate and appropriate medical attention. If treated correctly and right away, the outlook for endophthalmitis is usually considered to be good.

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