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Department

Internal Medicine; Hospitalist Program

Position/Job Title

Residents; Physician

Description

Introduction: Endophthalmitis, a potentially devastating eye infection, can arise from various sources, including trauma, surgery, or intraocular injections. We present a case report of a patient with systemic signs of infection and bilateral eye erythema, whose condition rapidly deteriorated. Swift recognition of the symptoms and timely intervention by the medical team led to a conclusive diagnosis of endophthalmitis. The patient underwent anterior chamber (AC) washout and intravitreal injections, resulting in partial vision recovery. This case emphasizes the critical importance of early diagnosis and intervention to prevent irreversible vision loss and underscores the necessity of proactive management strategies.

Case Presentation: An 85-year-old female presented to our community hospital with concerns of progressively worsening fatigue and weakness over the past three days. Evaluation in the emergency department (ED) revealed sepsis with no apparent source of infection, leading to her admission for overnight antibiotic treatment. During the night, her vision deteriorated significantly, and she reported seeing "black specs" in both eyes. The following day, she experienced substantial bilateral blurred vision and eye discharge, which was promptly communicated to the rounding resident. A physical examination of her eyes revealed erythema of the bilateral conjunctiva and yellowish-green drainage. Blood cultures collected upon her presentation in the ED showed positive results for group G streptococcus. With the absence of an obvious source of infection but the presence of new information and corresponding eye examination findings, there arose a growing suspicion that the patient might be suffering from endophthalmitis, which could potentially be the source of her sepsis. As our community hospital lacked ophthalmology services, arrangements were made to transfer the patient to a tertiary care facility that had in-house ophthalmology services. Subsequently, a diagnosis of endophthalmitis was confirmed at the tertiary care facility. To address the condition, the patient underwent an anterior chamber (AC) tap and received intravitreal injections of vancomycin, ceftazidime, and dexamethasone bilaterally. Cultures obtained from the left eye revealed growth of streptococcus G. Following these interventions, the patient was taken to the OR for an (AC) washout and additional intravitreal injections of vancomycin, ceftazidime, and dexamethasone. The intraoperative note indicated the presence of a significant amount of debris in the vitreous chamber of both eyes.

Discussion: Endophthalmitis, an uncommon yet sight-endangering eye infection, is typically caused by harmful bacteria or other pathogens entering the eye through the bloodstream. Our patient, who already had macular degeneration, experienced a sudden and severe deterioration in vision. This raised our suspicion for endophthalmitis, especially given the presence of sepsis without an identifiable infection source. Recognizing the urgency of the situation, we expedited the patient's transfer to a specialized eye care center for immediate treatment. This decision was guided by the need for specialized ophthalmological expertise and resources to address both the underlying infection and the pre-existing ocular condition. Our approach underscores the critical importance of prompt diagnosis and intervention in cases of suspected endophthalmitis to prevent irreversible vision loss.

Conclusion: Acute endophthalmitis is not just a rare occurrence; it's a medical emergency demanding immediate attention. Swift action, including timely administration of intravitreal antibiotics and potential vitrectomy, is pivotal for favorable outcomes, especially in severe instances. While systemic antibiotics are vital, particularly for endogenous bacterial and fungal causes, multiple intravitreal injections might be needed if systemic therapy falls short. Remember, early treatment initiation is not just crucial—it's the key to halting irreversible blindness and ensuring full vision recovery. So, when it comes to endophthalmitis, every moment counts in preserving sight.

Publication Date

4-16-2024

Acute Endophthalmitis: A Case Report Highlighting the Importance of Swift Diagnosis and Intervention

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