The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Post-operative endophthalmitis, is a rare but sight-threatening complication of ocular surgery and intravitreal injections. It is usually caused by bacteria getting into the eye from the surrounding skin and contaminated surgical equipment. This Clinical Management Guideline outlines the aetiology, signs, symptoms and evidence-based recommendations for diagnosing post-operative endophthalmitis. It emphasises the need for emergency referral and outlines the possible treatment options including surgery for severe cases.
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What is endophthalmitis?
The most frequently performed eye operation is cataract surgery and it is normally highly successful in restoring vision. However, in a very small proportion of cases (fewer than one per thousand) it is complicated by infection (endophthalmitis), usually caused by common bacteria such as those on the patient’s own skin. Endophthalmitis (which means inflammation inside the eye) can also occasionally be caused by retained surgical material (e.g. cotton fibres). It is called ‘acute’ if it occurs within the first week after surgery and ‘chronic’ if it occurs up to a month after surgery. It occurs more often in patients who are diabetic or who have an infection or drug treatment that suppresses the immune system.
Endophthalmitis causes pain, redness, undue light sensitivity and blurred vision when it is acute; symptoms are less severe when it is chronic. The signs seen by the optometrist or the ophthalmologist are typical of inflammation within the eye.
How is endophthalmitis managed?
If the optometrist suspects endophthalmitis, the recommendation is emergency (same day) referral to an ophthalmologist, who will usually admit the patient to hospital. A specimen is taken from within the eye so that the infecting organism can be identified and antibiotic is placed directly inside the eye. Sometimes surgery is required to remove the vitreous (the jelly inside the eye).
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