Postoperative Bacterial Endophthalmitis

Clinical Description

Infectious endophthalmitis shortly after ocular surgery (24 – 48 hours)

Signs and Symptoms

• Loss of vision, pain and tearing, purulent discharge and lid swelling/oedema
• Conjunctiva injection, hypopyon, corneal edema, vitritis, reduced fundus view secondary to vitreous inflammation

Investigations

Vitreous tap (microscopy, culture, and sensitivity)

Treatment

• Intravitreal antibiotics are the key to management.
• Empirical treatment Intravitreal Injections
• Vancomycin (1mg in 0.1ml) and Ceftazidime (2.25mg in 0.1ml) OR
• Vancomycin (1mg in 0.1ml and Amikacin (O.4mg in 0.1ml) if penicillin allergy
• Periocular Antibiotic Injections
• Vancomycin 2.5 mg in 0.5 ml and Ceftazidime 100 mg in 0.5 ml OR
• Vancomycin 2.5 mg in 0.5 ml and Amikacin 2.5 mg in 0.S ml OR
• Vancomycin 2.5 mg in 0.5 ml and Gentamicin 20 mg in 0.5 mL
• Topical treatment:
• Ciprofloxacin/moxifloxacin/ofloxacin eye drops hourly and atropine eye drops 12 hourly
• then add Dexamethasone eye drops 8 hourly after 2 days
• Oral steroids: Prednisolone po 1-1.5mg/kg
• Oral Antibiotics (Are of uncertain benefit).
• Fluoroquinolones e.g., Ciprofloxacin 750 mg 12 hourly for 7-10 days
• Steroids
• Periocular steroids e.g., Dexamethasone 6 mg in 0.25 ml OR

Triamcinolone 1mg should be considered if systemic steroids are contraindicated