5 Cases of endophthalmitis related to Escherichia coli and Klebsiella have been associated with diabetes, liver disease and urinary tract infections. The key to acute management of endogenous endophthalmitis is prompt administration of intravenous antibiotics. Candida is the most common organism causing endogenous endophthalmitis. 8 Risk factors for infection with this organism include intravenous drug use, surgery, malignancies, intravenous hyperalimentation, endovascular lines, diabetes, neutropenia and the use of broad-spectrum antibiotics and immunosuppressive medications, especially corticosteroids. Clinical Manifestations and Diagnosis A high degree of suspicion is necessary to make an early diagnosis of endogenous endophthalmitis.
Patients commonly complain of eye pain, blurring of vision, ocular discharge and photophobia.
The risk factors mentioned above should be elicited, in addition to symptoms that suggest the presence of the primary infection. Patients who present at a later stage in the disease may have obvious signs such as chemosis, proptosis and hypopyon. Slit lamp examination and ocular ultrasonography should be performed to look for anterior vitreous haze echoes and retinochoroidal thickening. Clinicians must be more aware of the need to examine the eyes of extremely ill and sedated patients, such as those in intensive care units. Identifying the primary source of infection also requires a thorough examination.