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].

• Fever

  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]

  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]

• Nightmare

  Abstract Occurrence of postoperative cluster endophthalmitis is a nightmare for the operating surgeon, the involved hospital, and the patients. [ncbi.nlm.nih.gov]

• Wrist Pain

  A previously healthy 42-year-old man presented to the Emergency Department with chills, fever, left wrist pain, left eye pain, and vision loss. [ncbi.nlm.nih.gov]

• 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]

• Visual Acuity Decreased

  The visual acuity decreased to hand motions or light perception postoperatively. The culture of aqueous and vitreous of the 2 eyes revealed Staphylococcus epidermidis and enterococcus faecalis respectively, however was negative for the third eye. [ncbi.nlm.nih.gov]

  Common symptoms and signs of acute infective exogenous endophthalmitis Symptoms Signs Visual blurring or loss Pain Purulent discharge Decreased visual acuity Decreased red reflex Eyelid oedema Conjunctival injection and chemosis Anterior chamber cells [racgp.org.au]

  acuity decreased below the level expected Lid edema Conjunctival hyperemia Corneal edema Anterior chamber cells and flare Keratic precipitates Hypopyon [5] Fibrin membrane formation Vitritis Loss of red reflex Retinal periphlebitis if view of fundus [emedicine.medscape.com]

• Corneal Opacity

  opacity. 6 Figure 1. [retinatoday.com]

  Permanent loss of vision in patients with AOPE can occur through a variety of mechanisms, including retinal detachment, hypotony, and corneal opacity. [academic.oup.com]

• Vitreous Floaters

  floaters, conjunctival haemorrhage, eye irritation, foreign body sensation in eyes, lacrimation increased, blepharitis, dry eye, ocular hyperaemia, eye pruritus et Nii pikalt ette pole me veel mõelnud en The most common side effects with Lucentis (seen [et.glosbe.com]

• 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]

  […] prematurity Rx: Intravenous antibiotics, intravitreal antibiotics, and enucleation 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 [ajnr.org]

  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].

• Cavitary Lesion

  She was found to have a pulmonary cavitary lesion and fluffy white material in the anterior chamber. An aqueous and vitreous paracentesis grew Coccidioides species. [ncbi.nlm.nih.gov]

• Streptococcus Bovis

  We report a case with bacterial endogenous endophthalmitis caused by Streptococcus bovis, developed after colonoscopy, which had a poor outcome and resulted in evisceration. [ncbi.nlm.nih.gov]

• Salmonella Typhi

  To report a rare case of Salmonella typhi associated endogenous endophthalmitis in an immunocompetent male and to review the available literature. Retrospective chart review. [ncbi.nlm.nih.gov]

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.