Page 115 - NAME OF CONDITION: REFRACTIVE ERRORS

negative and gram positive spectrum of causative organisms. Role of systemic
antibiotics are debatable considering its low intraocular bioavailability.

After initial treatment of endophthalmitis a fraction of patients would require further
treatment, mainly for worsening ocular infection or complication from the initial
procedure. It typically requires more than 48hrs to observe an improvement in the
clinical appearance after initial treatment. But one needs to keep in mind that the

treated eyes look somewhat worse 1 day after treatment before improving
subsequently.
ii) Traumatic endophthalmitis: When the diagnosis of traumatic endophthalmitis is

established, aqueous and vitreous specimen should be obtained for culture and Gram
stain. Intravitreal injection with appropriate antimicrobial agent may be given as an
initial treatment. But the guidelines for postoperative endophthalmitis treatment may
not be applicable for traumatic endophthalmitis because of the diversity of the
organisms encountered. Early closure of the wound, removal of foreign body and
Vitrectomy in patients with severe vitritis should be the standard of care in all cases of
traumatic endophthalmitis where the injury involves a rupture of ocular coats, or
rupture of lens. Patients who do not respond after 48hrs or rapidly deteriorate in the

first 24hrs following intravitreal antibiotics should also be treated with vitrectomy. Just
like postoperative endophthalmitis, the exact role of systemic antimicrobial therapy
for traumatic endophthalmitis is unclear.
Endogenous endophthalmitis: In contrast to postoperative endophthalmitis and

traumatic endophthalmitis, systemic antibiotics are central to treatment of the
endogenous endophthalmitis, since the source of infection is often remote to eyes. A
detailed systemic workup including a general physical examination with special
attention to the heart, skin and extremities should be carried out to look for the
source of origin of the infection. When the source of infection is not apparent, special
diagnostic studies like echocardiogram, abdominal ultrasonography, culture of blood
and urine should be done. Cases of endogenous endophthalmitis with mild
inflammation (e.g., focal metastatic abscesses in the anterior or posterior segment)

may be treated initially with topical and systemic therapy, using nonocular cultures to
guide treatment. Intravitreal antibiotic injection may be indicated if: 1) the
inflammatory focus is in the anterior segment, and the eye is aphakic, or there is a
dehiscence in the posterior capsule; or 2) the inflammatory focus is in the posterior
segment, and there is significant vitritis. If no improvement is seen within a reasonable
length of time or if nonocular cultures are negative, biopsy is indicated. Unlike cases of
postoperative or posttraumatic endophthalmitis, the vitreous may not be the principal

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