ESCRS Guidelines on prevention, investigation and management of

3. Diagnosis
3.1 Commencement and symptoms
Acute early endophthalmitis after cataract operations commences between the first post-operative day and
approximately two weeks after the operation. It is associated in 74 to 85 per cent with ocular pain and in >
90 per cent with reduced vision [15], [122]. It is characterised in 75 to 86 per cent by hypopyon, in > 80
per cent by a red eye and in 35 per cent by lid swelling [141]. Additionally, there can be corneal oedema
and involvement of the posterior segment (refer to chart below) [205].
Chronic late endophthalmitis after cataract operations commences only after two weeks but may also take
many months to appear [50], [96], [113], [117]. It is usually caused by Propionibacterium acnes, S.
epidermidis (CNS), diphtheroids and fungi [15], [122]. In P. acnes endophthalmitis, whitish plaques are
found in the capsular sac in 40 to 89 per cent [50], [62], [205]. Hypopyon is found in 67 per cent, corneal
oedema in 48 per cent and keratitis in 26 per cent of cases of fungal endophthalmitis [113], [124];
pyramid-shaped hypopyon is typical of a mycotic cause [204], [210]. Refer to chart below.
The course and final outcome depend on the type and number of pathogens. In 44 to 53 per cent there is
an achievement of only one metre vision with bacterial infection [15], [122], and similar for fungal infection
in 41 to 70 per cent of patients [113], [151]. Endophthalmitis after pars plana vitrectomy has a poorer
prognosis than after cataract or glaucoma surgery [46], [63].
The diagnosis of acute bacterial endophthalmitis is a medical emergency requiring an immediate vitreal tap
and instillation of intravitreal antibiotics and corticosteroid.
Figure 3.1 Early presentation of acute endophthalmitis
due to Streptococcus mitis
(Courtesy of Suleyman Kaynak)
Figure 3.2 Presentation of acute endophthalmitis
due to Staphylococcus aureus
(Courtesy of Uwe Pleyer)
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