Management of Endogenous Endophthalmitis
Endogenous endophthalmitis is a potentially blinding ocular infection resulting from hematogenous spread from a remote primary source. Endogenous endophthalmitis accounts for only 2–8% of cases of endophthalmitis and usually occurs in the setting of at least a relatively immunocompromised state. Causes include both gram-positive and gram-negative bacteria and fungi. Streptococcal species are the most commonly implicated bacterial organisms; Candida species are the most commonly implicated fungal organisms. Endogenous mold endophthalmitis is rare and typically occurs in the setting of relative immunocompromise or intravenous drug use. Early diagnosis of endogenous endophthalmitis requires a high degree of suspicion and is critical if vision is to be preserved. Therapeutic management includes hospitalization and delivery of broad-spectrum systemic and intravitreal antibiotics. Vitrectomy may be appropriate in some cases. The prognosis of patients with endogenous endophthalmitis is disappointing; even with aggressive treatment, useful vision (i.e., ability to count fingers or better) is preserved in only about 40% of patients.
KeywordsCandida Species Intravitreal Injection Endogenous Endophthalmitis Fungal Endophthalmitis Intravenous Hyperalimentation
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