Endophthalmitis Related With Infectious Uveitis: Clinic, Diagnosis, Treatment

Metastatic endogenous endophthalmitis is a rare but serious ocular infection by seeding of bacteria or fungi into the eye from a source elsewhere in the body. Studies suggest that endogenous endophtlamitis account for 2 to 8% of all endophthalmitis. In North America and Europa, the most identified causative bacteria are Staphylococcus aureus and Streptococcus pneumonia, while in East Asia, Klebsiella pneumonia is chiefly responsible. Among fungal etiologies; Candida albicans is the most common yeast, and Aspergillus is the most common mold. Major risk factors are immunocompromised states (for example, chronic corticosteroid use, malignancy, end-stage liver / renal disease, organ transplant, diabetes mellitus), intravenous drug use and indwelling catheter. A key diagnostic finding is the presence of white infiltrate originating in the choroid and sometimes erupting in the vitreous cavity. The fundus may be obscured because of vitreous haze or vitritis. Patients’ presentation and history are important in diagnosis. Depending on suspected primary locus of infection, blood, urine and other cultures are done. Also vitreous tap must be obtained. Hospitalization, infectious disease consultation, systemic therapy with antibiotics or antifungals should be started. Then, aggressive intravitreal antibiotic therapy, with or without pars plana vitrectomy, should be added to the regiment Early diagnosis is crucial because of delay of treatment is the factor most associated with poor visual prognosis.