Management of Endogenous Endophthalmitis

  • Kapil G. Kapoor
  • Gibran S. Khurshid
  • Garvin H. Davis
  • Bernard F. Godley
Part of the M.D. Anderson Solid Tumor Oncology Series book series (MDA, volume 6)


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.


Candida Species Intravitreal Injection Endogenous Endophthalmitis Fungal Endophthalmitis Intravenous Hyperalimentation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Okada AA, Johnson RP, Liles WC, et al. Endogenous bacterial endophthalmitis. Report of a 10-year retrospective study. Ophthalmology 1994;101:832–8.PubMedGoogle Scholar
  2. 2.
    Leibovitch I, Lai T, Raymond G, et al. Endogenous endophthalmitis: a 13-year review at a tertiary hospital in South Australia. Scand J Infect Dis 2005;37(3):184–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Ness T, Pelz K, Hansen LL. Endogenous endophthalmitis: microorganisms, disposition, and prognosis. Acta Ophthalmol Scand 2007;85(8):852–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmology 1982;89(7):789–96.PubMedGoogle Scholar
  5. 5.
    Tanaka M, Kobayashi Y, Takebayashi H, et al. Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12-year study of 79 eyes of 46 patients. Retina 2001;21(3):203–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Schiedler V, Scott IU, Flynn HW Jr, et al. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol 2004;137(4):725–31.PubMedGoogle Scholar
  7. 7.
    Hawkins AS, Deutsch TA. Infectious endophthalmitis. Curr Infect Dis Rep 1999;1(2):172–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Godley BF, Folk JC. Retinal hemorrhages as an early sign of acute bacterial endophthalmitis. Am J Ophthalmol 1993;116:246–9.Google Scholar
  9. 9.
    Miailhes P, Labetoulle M, Naas T, et al. Unusual etiology of visual loss in an HIV-infected patient due to endogenous endophthalmitis. Clin Microbiol Infect 2001;7(11):641–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Perri P, Campa C, Incorvaia C, et al. Endogenous Aspergillus versicolor endophthalmitis in an immuno-competent HIV-positive patient. Mycopathologia 2005;160(3):259–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Ramakrishnan R, Bharathi MJ, Shivkumar C, et al. Microbiological profile of culture-proven cases of exogenous and endogenous endophthalmitis: a 10-year retrospective study. Eye 2008;23(4):945–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Essman TF, Flynn HW Jr, Smiddy WE, et al. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers 1997;28:185–94.PubMedGoogle Scholar
  13. 13.
    Anand A, Madhavan H, Neelam V, et al. Use of polymerase chain reaction in the diagnosis of fungal endophthalmitis. Ophthalmology 2001;108(2):326–30.PubMedCrossRefGoogle Scholar
  14. 14.
    Durand ML, Kim IK, D’AMico DJ, et al. Successful treatment of fusarium endophthalmitis with voriconazole and Aspergillus endophthalmitis with voriconazole plus caspofungin. Am J Ophthalmol 2005;140:552–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Kunimoto DY, Kanitkar KD, Makar MS. The Wills Eye Manual, fourth edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2004.Google Scholar
  16. 16.
    Keswani T, Ahua V, Changulani M. Evaluation of outcome of various treatment methods for endogenous endophthalmitis. Indian J Med Sci 2006;60(11):454–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Desai M, Rapoor R, Gudithi SL, et al. Endophthalmitis: a rare complication of arteriovenous fistula infection. Hemodial Int 2008;12(2):227–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Hsu KH, Ben RJ, Shiang JC, et al. Pseudomonas aeruginosa endocarditis associated with endophthalmitis caused by arteriovenous fistula and graft infection. J Chin Med Assoc 2003;66(10):617–20.PubMedGoogle Scholar
  19. 19.
    Callegan MC, Cochran DC, Kane ST, et al. Virulence factor profiles and antimicrobial susceptibilities of ocular bacillus isolates. Curr Eye Res 2006;31(9):693–702.PubMedCrossRefGoogle Scholar
  20. 20.
    Fang CT, Lai SY, Yi WC, et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 2007;45:284–93.PubMedCrossRefGoogle Scholar
  21. 21.
    Popovich K, Malani PN, Kauffman CA, et al. Compliance with Infectious Diseases Society of America guidelines for ophthalmologic evaluation of patients with candidemia. Infect Dis Clin Pract 2007;15:254.CrossRefGoogle Scholar
  22. 22.
    Edwards JE Jr, Foos RY, Montgomerie JZ, et al. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous candida endophthalmitis. Medicine (Baltimore) 1974;53:47–75.CrossRefGoogle Scholar
  23. 23.
    Donahue SP, Greven CM, Zuravleff JJ, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology 1994;101:1302–9.PubMedGoogle Scholar
  24. 24.
    Lamaris GA, Esmaeli B, Chamilos G, et al. Fungal endophthalmitis in a tertiary care cancer center: a review of 23 cases. Eur J Clin Microbiol Infect Dis 2008;27:343–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Kannangara S, Shindler D, Kunimoto DY, et al. Candidemia complicated by endophthalmitis: a prospective analysis. Eur J Clin Microbiol Infect Dis 2007;26:839–41.PubMedCrossRefGoogle Scholar
  26. 26.
    Riddell J, McNeil SA, Johnson TM, et al. Endogenous Aspergillus endophthalmitis: report of three cases and review of the literature. Medicine (Baltimore) 2002;81:311–20.CrossRefGoogle Scholar
  27. 27.
    Kramer M, Kramer MR, Blau H, et al. Intravitreal voriconazole for the treatment of endogenous Aspergillus endophthalmitis. Ophthalmology 2006;113:1184–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Kapil G. Kapoor
    • 1
  • Gibran S. Khurshid
    • 1
  • Garvin H. Davis
    • 2
  • Bernard F. Godley
    • 2
  1. 1.Department of Ophthalmology and Visual SciencesThe University of Texas Medical BranchGalvestonUSA
  2. 2.Department of OphthalmologyThe University of Texas at HoustonHoustonUSA

Personalised recommendations