Depending on the cause, the clinical presentation may somewhat vary:

• Postoperative - Cataract surgery, secondary intraocular lens (IOL) implantation, penetrating keratoplasty, glaucoma drainage device implantation, trabeculectomy and vitreous procedures (vitrectomies or intravitreal injections) have all been associated with an increased risk for postoperative endophthalmitis [1] [2]. Symptoms can develop within the first six weeks (acute-onset) or after six weeks (delayed- onset) [1] [3]. Decreased visual acuity, eye pain, eyelid edema, ocular discharge, inability to visualize the fundus and hypopyon are typical signs, while the loss of red fundus reflex, light perception, and papillitis are seen in more severe cases [3] [4]. An insidious and prolonged clinical course is common for delayed-onset endophthalmitis [3] [4].
• Posttraumatic - Approximately 25% of endophthalmitis occurs in the setting of ocular trauma [3], with decreased vision, swelling of the eyelid, severe eye pain, uveitis, vitritis, hypopyon and presence of corneal ring ulcers being the most important symptoms [3].
• Endogenous - Symptoms of endophthalmitis as a result of hematogenous spread of bacterial or fungal organisms may be similar to exogenous forms, the most important signs being reduced visual acuity, eyelid edema, eye pain, and hypopyon [5]. Additionally, photophobia and the presence of floaters can also be reported in the majority of patients [5]. An absence of the red fundus reflex along with corneal edema and impaired visualization of the fundus, like in other forms, is frequently observed [5].

• Pain

  If left untreated it may lead to painful, loss of vision. Though rare, it does occur and needs treatment on war footing. [drushti.com]

  The patient experienced pain in the right knee with signs of effusion and arthrocentesis was performed. [revistanefrologia.com]

  Presentation [ 2 ] Presentation is usually acute, with eye pain and decreased vision. The eyelid may be swollen (about one third of cases) Occasionally the condition is not painful. [patient.info]

  Endophthalmitis caused by bacteria cause pain, redness of eyes and swelling of eyelids. Fungal endophthalmitis may generally persist on the ocular cavities for weeks together causing blurred vision and pain. [diseasespictures.com]

• Fever

  The patient was hospitalised due to general decline, fever and dyspnoea. As a respiratory infection was suspected, systemic empirical antibiotic coverage was provided with ceftriaxone. [revistanefrologia.com]

  A detailed elicitation of history revealed that patient had been treated for enteric fever that presented with diarrhea and fever, two weeks prior to current presentation. [ncbi.nlm.nih.gov]

  The patient's systemic and ocular condition improved and the patient no longer had fever. [scielo.br]

• Falling

  While it is generally accepted that the intraocular delivery of steroids in postoperative endophthalmitis is beneficial, their use in endogenous endophthalmitis is more controversial and the authors fall on the side of usage without any real evidence [nature.com]

  There may be fever, severe fall of blood pressure etc. Candida Endophthalmitis Candia species may infect the eye as well. This may occur after eye surgery or after injury of the eye or spread via blood stream in invasive candidiasis. [news-medical.net]

  Intraocular inflammation increases the permeability of the blood–ocular fluid barrier, enhancing penetration of systemic antibiotics into the vitreous cavity. 26 However, intravitreal levels achieved vary substantially, frequently falling below the minimum [touchophthalmology.com]

  Int Ophthalmol Clin. 2000 Fall;40(4):51-7. [reviewofoptometry.com]

• Collapse

  […] positive culture in 4.2% of eyes Can obtain at the time of PPV, if indicated Method of Obtaining Samples Eye surgically prepped with povidone-iodine 5% solution Surgical drape, lid speculum 30g needle attached to TB syringe  limbus for A/C tap, without collapsing [eyewiki.aao.org]

  When the technique of vitrectomy biopsy is used, infusion is usually recommended to prevent the globe from collapsing.5859 Doft and Donelly recommend a single sclerotomy vitreous biopsy technique without infusion, which avoids additional sclerotomy openings [bjo.bmj.com]

• Weight Loss

  Common cold with headache and unintentional body weight loss was also noted recently. Choroidal detachment simulating choroidal tumor was observed in the temporal quadrant. [ncbi.nlm.nih.gov]

  Review of systems was significant for 20- to 30-lb weight loss in the month preceding presentation. The patient’s past medical history was notable for hypertension. [joii-journal.springeropen.com]

• Ulcer

  Scott IU et al. found that 3 (21.4%) out of 14 patients with corneal ulcer underwent evisceration or enucleation8. [nature.com]

  Despite the culture-demonstrated sensitivity of this organism to the antibiotics given intravitreally, systemically, and topically to treat this infection, her condition deteriorated, and she developed panophthalmitis, orbital cellulitis, a corneal ulcer [doi.org]

  On ophthalmic examination, the left pupil was noted to be 2mm and sluggish, there was mild chemosis and conjunctival injection; slit lamp exam revealed no fluroscein uptake, no ulcers or dendritic ulcers. There was no relief with proparacaine. [epmonthly.com]

• Eye Pain

  Decreased visual acuity, eye pain, eyelid edema, ocular discharge, inability to visualize the fundus and hypopyon are typical signs, while the loss of red fundus reflex, light perception, and papillitis are seen in more severe cases. [symptoma.com]

  He complained of a headache and blurry vision but denied having eye pain. Slit-lamp examination demonstrated leukocytes with a fibrinous membrane in the anterior segment and vitritis. [ncbi.nlm.nih.gov]

  (M2.OP.1) A 67-year-old man presents to the emergency room with eye pain. He notes that his right eye has become progressively more painful over the past day and that his vision has been worsening. [step2.medbullets.com]

• Corneal Edema

  Corneal Edema It is exceedingly rare to have limbal-to-limbal, 360? corneal edema on the first postoperative day. [crstoday.com]

  An ophthalmic examination showed light perception vision, corneal edema with severe anterior chamber reaction and hypopyon, exudative membranes on the anterior lens surface, and dense vitreous exudates. [ncbi.nlm.nih.gov]

  Physicians can also assess the appearance of the cornea; with TASS, limbus to limbus corneal edema is common, but with endophthalmitis, the edema usually doesn’t extend that far. [eyeworld.org]

• Chemosis

  Biomicroscopy of the right eye (OD) revealed chemosis (edema) and conjunctival hyperemia 2+/4+, transparent cornea and fibrin in theanterior chamber (AC) ( Figure 1 ); the left eye (OS) presented chemosis and conjunctival hyperemia 2+/4+, transparent [scielo.br]

  Symptoms: reduced vision, hyperemia, ocular pain or chemosis may be misinterpreted as postoperative inflammatory reaction. [columbiaeye.org]

  Conjunctival chemosis, corneal haze, and hypopyon were noted and yellowish exudates filled the vitreous cavity. [ncbi.nlm.nih.gov]

  The patient later presented with ptosis of the left eyelid, severe conjunctival chemosis, decrease in visual acuity upon light perception, preseptal cellulitis, almost complete ophthalmoplegia, ocular hypertension and anterior chamber fibrin. [revistanefrologia.com]

  Physical examination can reveal swollen eyelids, chemosis, conjunctival injection, corneal edema, reduced red reflex, reduced visual acuity and raised intraocular pressure. [radiopaedia.org]

• Photophobia

  Generally, patient complains of sudden loss of vision, pain, redness, swelling of the eye, headache, and photophobia. However severity of symptoms may depend on the causative organism. [drushti.com]

  Symptoms : Symptoms of endophthalmitis includes loss of vision (partial), blurred vision, headache, pain in the eyes, photophobia, ocular discharge and intense ocular inflammation. [diseasespictures.com]

  The main presenting symptoms were photophobia (50%) and pain (40.9%). The most common signs were conjunctival injection (36.4%) and hypopyon (31.8%). The final visual acuity was counting fingers or worse in 86% of cases. [ncbi.nlm.nih.gov]

• Conjunctival Injection

  There is conjunctival injection and subconjunctival haemorrhage following the intravitreal antibiotic injections Figure 2. Infected trabeculectomy bleb at the superior limbus. [racgp.org.au]

  The most common signs were conjunctival injection (36.4%) and hypopyon (31.8%). The final visual acuity was counting fingers or worse in 86% of cases. The most common cultured organism was Staphylococcus aureus (31.8%). [ncbi.nlm.nih.gov]

  Signs: May present with conjunctival injection and chemosis Corneal edema Corneal infiltrate or abscess Anterior chamber reaction i.e. cells, flare, fibrin or hypopyon, vitritis May be complicated with retinal involvement Risk factors: organisms from [columbiaeye.org]

  Physical examination can reveal swollen eyelids, chemosis, conjunctival injection, corneal edema, reduced red reflex, reduced visual acuity and raised intraocular pressure. [radiopaedia.org]

• Headache

  He complained of a headache and blurry vision but denied having eye pain. Slit-lamp examination demonstrated leukocytes with a fibrinous membrane in the anterior segment and vitritis. [ncbi.nlm.nih.gov]

  Generally, patient complains of sudden loss of vision, pain, redness, swelling of the eye, headache, and photophobia. However severity of symptoms may depend on the causative organism. [drushti.com]

  Symptoms : Symptoms of endophthalmitis includes loss of vision (partial), blurred vision, headache, pain in the eyes, photophobia, ocular discharge and intense ocular inflammation. [diseasespictures.com]

A thorough patient history is the first step in workup, as it can reveal vital clues regarding risk factors and pathogenesis of eye-related problems. Many authors suggest that typical signs and symptoms encountered in endophthalmitis are sufficient to make a diagnosis [1] [4] [5], but fundoscopy and a slit-lamp examination to support these findings must be performed. Vitritis, corneal infection, hypopyon, and clumps of thick material in the anterior chamber are some of the most common findings [4]. Imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT scan) must be performed in the post-traumatic eye injury to exclude the presence of foreign bodies in other sites [1]. To confirm the underlying cause and determine optimal therapy, microbiological studies are necessary. A sampling of the vitreous humor, either by performing a vitrectomy or needle aspiration, is needed in order to obtain a viable sample for the investigation [4] [5]. Identification of bacterial or fungal pathogens are performed by culturing the samples in specific media, and vitrectomy carries a significantly higher rate of positive results compared to needle sample aspiration [4]. Detection of microorganisms by molecular techniques - polymerase chain reaction (PCR) and matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) has recently emerged as a novel method with superior results compared to cultivation and other laboratory tests (eg. serology), but their introduction in regular practice is yet to occur [1] [2] [5].

Treatments for endogenous endophthalmitis include systemic and intravitreous antibiotics. Treatment duration should be determined based on the need to treat the underlying cause of bacteraemia. [revistanefrologia.com]

Fundus photographs Treatment of Endophthalmitis Once the diagnosis is made, prompt treatment is mandatory for better visual outcome. Treatment depends on the underlying cause of endophthalmitis. [drushti.com]

Treatment • Bacterial endogenous endophthalmitis. [reviewofophthalmology.com]

Antibiotic treatment should be aimed at these bacterial species. Definitive treatment, however, requires intra-vitreal antibiotic injections. For this reason, immediate ophthalmology involvement is needed after systemic antibiotics are started. [emdocs.net]

TREATMENT OF FUNGAL ENDOPHTHALMITIS Since the first reported successful treatment of candida endophthalmitis with parenteral amphotericin B in 1960,91this drug has become the treatment of choice of intraocular fungal infections. [bjo.bmj.com]

The prognosis was poor with 48% demonstrating a visual acuity of LP or NLP at the final follow-up. [ncbi.nlm.nih.gov]

S. marcescens endophthalmitis has a poor visual prognosis and may show an in vivo clinical resistance to antibiotic therapy regardless of in vitro culture sensitivities. [journals.lww.com]

Treatment and prognosis In acute cases, treating endophthalmitis is an emergency and needs to be performed as soon as possible. The procedure performed will depend on your vision. [asrs.org]

Age An association appears to exist between the development of endophthalmitis in cataract surgery and age greater than or equal to 85 years. [8] Prognosis The prognosis is extremely variable because of the variety of organisms involved. [emedicine.medscape.com]

Prognosis The visual acuity at the time of the diagnosis and the causative agent are most predictive of outcome. Acute postoperative endophthalmitis has a poor prognosis with 55% of eyes managing 6/60 or less. [patient.info]

METHODS: All cases diagnosed as endophthalmitis of any etiology and undergoing treatment which progressed to panophthalmitis from January 2005 to December 2015 were included. [ncbi.nlm.nih.gov]

Infectious endophthalmitis can have either an exogenous (following ocular surgery/penetrating trauma) or endogenous (hematogenous spread) etiology. [amboss.com]

Etiology Bacterial endophthalmitis has been classified as exogenous or endogenous depending on the cause. [radiopaedia.org]

Propionibacterium acnes are the most common cause of delayed-onset endophthalmitis, and fungi, particularly Candida spp., are also important in the etiology of these infections. [ophthalmologytimes.com]

The epidemiology of the disease is very different in Scandinavia compared to Asia. The visual prognosis remains grave and the majority of the eyes lose useful vision. [ncbi.nlm.nih.gov]

An epidemiologic investigation by the Thai Field Epidemiology Training Program included a retrospective review of hospital records of all patients who had had cataract operations (predominantly ECCEs) in 1992, a case-control study to determine risk factors [cdc.gov]

Epidemiology Endogenous endophthalmitis can occur at any age and has no sexual predilection. [aafp.org]

In fact, a number of studies have specifically looked at the pathophysiology of this particular infection. [joii-journal.springeropen.com]

Introduction Overview intraocular bacterial or fungal infection Epidemiology risk factors ocular trauma eye surgery keratitis extending into the eye systemic infection Pathophysiology ocular trauma or eye surgery bacterial of fungal introduction within [step2.medbullets.com]

Pathophysiology Under normal circumstances, the blood-ocular barrier provides a natural resistance against invading organisms. [emedicine.medscape.com]

Pathophysiology Normally, the blood-ocular barrier prevents invasion from infective organisms but if this is breached (directly through trauma or indirectly due to a change in its permeability secondary to inflammation), infection can occur. [patient.info]

Preoperative topical antibiotics reduce the bacterial load on the ocular surface, but there are no studies proving that they effectively prevent endophthalmitis. [crstodayeurope.com]

Systematic collection of data and periodic evaluation of the current practice against the new evidence are necessary to prevent or treat postcataract surgery endophthalmitis. [ncbi.nlm.nih.gov]

Antibiotic prevention of postcataract endophthalmitis: a systematic review and meta-analysis. Acta Ophthalmol. 2015 Mar 16. [Medline]. Alfaro DV, Roth D, Liggett PE. Posttraumatic endophthalmitis. Causative organisms, treatment, and prevention. [emedicine.medscape.com]

1. Vaziri K, Schwartz SG, Kishor K, Flynn HW Jr. Endophthalmitis: state of the art. Clin Ophthalmol. 2015;9:95-108
2. Safneck JR. Endophthalmitis: A review of recent trends. Saudi J Ophthalmol. 2012;26(2):181-189.
3. Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol. 2010;4:121-135.
4. Durand ML. Endophthalmitis. Clin Microbiol Infect. 2013;19(3):227-234.
5. Sadiq MA, Hassan M, Agarwal A, et al. Endogenous endophthalmitis: diagnosis, management, and prognosis. J Ophthalmic Inflamm Infect. 2015;5:32.