Endophthalmitis is an inflammation of the inner coats of the eyeball that can be infective or non-infective. Infective endophthalmitis is classified as exogenous or endogenous. Acute bacterial endophthalmitis is a complication of intraocular surgery where the infective source is usually the patient's own flora. Signs include lid edema, chemosis, hypopyon, and retinal periphlebitis. Treatment involves intravitreal and systemic antibiotics, intravitreal and topical steroids, and sometimes pars plana vitrectomy to treat severe or non-improving cases. Panophthalmitis is a more severe inflammation of the whole eyeball that

1. ENDOPHTHALMIT
IS

2. ENDOPHTHALMITIS
 Inflammation of the inner coats of eyeball
 Especially ant and post. chambers
Ant. Or post uveitis
Endophthalmitis
Panophthalmitis

3. CLASSIFICATION
Endophthalmitis
Infective
Exogenous
Endogenous
20 from
surrounding
Non infective
Post
operative
Post
Tramatic
Phacoanaphylactic
Intra ocular tumor
necrosis

4. Classification

5. STERILE
ENDOPHTHALMITIS
 Post operative sterile endophthalmitis
 Post traumatic endophthalmitis
 Phacoanaphylactic endophthalmitis
 Intra ocular tumor necrosis
Intraocular lens
instruments

6. ACUTE BACTERIAL
ENDOPHTHALMITIS
 Complication of intraocular surgery
 Infective source-patient’s own flora
 Symptoms
 Severe ocular pain
 Redness
 Lacrimation
 Photophobia
 Loss of vision

7. SIGNS
•Lid edema
•Chemosis
•Corneal clouding

8. SIGNS
 Hypopyon
 Fibrin membrane in ant.
chamber

9. SIGNS
 Wound gaping
 Yellow reflex
 Retinal periphlebitis
(early sign)

10. Investigations
Vitreous tap
•Topical anesthesia
•Trans conjunctively
•23-guage needle
•0.1ml aspirated
 Gram staining
 Sensitivity test
 culture

11. INVESTIGATIONS
 Fundoscopy
 B scan-Ultrasound

12. Differential diagnosis
 Occult retention of lens cortex or nucleus
 Hypopyon uveitis (Behcet’s or rifabutin)
 Blebitis
 Keratitis
 Toxic anterior segment syndrome (TASS)

13. TREATMENT
ANTIBIOTICS
Intravitreal
Topical
Systemic
VANCOMYCIN 1mg in 0.1ml + CEFTAZIDIME 2.25mg in 0.1ml
VANCOMYCIN 1mg in 0.1ml + AMIKACIN 0.4mg in 0.1ml
VANCOMYCIN or CEFAZOLINE
AMIKACIN or TOBRAMYCIN
CIPROFLOXACIN
VANCOMYCIN
CEFAZOLINE

14. TREATMENT
STEROIDS
 Intravitreal- DEXAMATHASONE(0.4mg in 0.1ml)
 Topical – DEXAMETHASONE(0.1%)
 Systemic – PREDNISOLONE

15. TREATMENT
 Cycloplegics - 1% atropine
 Antiglaucoma - Acetazolamide or Timolol

16. SURGICAL TREATMENT
 PARS PLANA VITRECTOMY
• Two port
• Three port

17. Assess visual
acuity
Only light
perception
Early
vitrectomy with
intra vitreal anti
biotics
Hand
movements
perceived
Vitreous tap
and culture
and intra vitreal
antibiotics
Improves
Doesnot
improve
Tap vitreous
and check
culture
Vitrectomy and
repeat culture

18. PANOPHTHALMITIS
 Intense pururlent inflammation of whole eye
ball
 Symptoms
Severe ocular pain n head ache
Complete loss of vision
Profuse watering
Purulent discharge
Marked redness and swelling

19.  Proptosis and painful movement of eyeball
 Lid edema
 chemosis
 Corneal edema n clouding
 Anterior chamber full of pus
 IOP
 Globe perforation
Signs

20. COMPLICATIONS
 Orbital cellulitis
 Cavernous sinus thrombosis
 Meningitis

21. TREATMENT
 Anti inflammatory n analgesic
 Broad spectrum antibiotic
 Evisceration