September 22, 2014
A 54-year-old man with pancytopenia presents to the emergency department with a 2-day history of left eye swelling, photophobia, excessive tearing, blurry vision, and frontal headache.
Endophthalmitis
- Endophthalmitis is defined as an infectious or noninfectious intraocular inflammatory process that is classified as exogenous or endogenous, depending on whether it resulted from direct or hematogenous inoculation, respectively.
- Exogenous endopthalmitis is most commonly the result of intraocular surgery, penetrating trauma, corneal ulcer, or periocular infection, where disruption of the external ocular layers allows infective agents access to the intraocular spaces.
- Key Diagnostic Features:
- Scleral thickening and enhancement
- Increased density or abnormal signal intensity of the vitreous chamber
- Subretinal collections that may demonstrate restricted diffusion
- Deformity of the ocular globe can be seen and may suggest progression to phthisis bulbi.
- Additional associated findings include preseptal and postseptal inflammation with the potential of complications, such as superior opthalmic vein thrombosis, cavernous sinus thrombosis, and intracranial infection.
- DDx:
- Retinoblastoma
- Coat disease
- Persistent hyperplastic primary vitreous
- Retinopathy of prematurity
- Rx: Intravenous antibiotics, intravitreal antibiotics, and enucleation
