Endophthalmitis
Endophthalmitis is an infection of the tissues inside the eye. It's a rare condition that can develop days or weeks after eye surgery, injury or due to infection from elsewhere in the body (endogenous).
Endophthalmitis needs urgent treatment with antibiotics or antifungal medicine to prevent sight loss. If you develop symptoms such as eye pain, redness, or worsening vision, especially after eye surgery, get urgent help at your local eye A&E department. The sooner you are treated, the better the outcome for your vision.
A diagram of a healthy eye with labels.
A diagram of an eye with endophthalmitis. The diagram shows inflammation in the vitreous or aqueous fluid in the eye.
Endophthalmitis symptoms
If you've had eye surgery or an eye injury, your ophthalmologist will probably explain the symptoms to be aware of that can indicate an infection causing endophthalmitis. Most cases happen within six weeks of surgery (Source: Healthline).
If you develop symptoms, it's essential to see an eye doctor urgently. Symptoms and signs of endophthalmitis include:
- Eye pain
- Red eyes
- Discharge from the eyes
- Blurred vision and/or decreased vision
- Swollen eyelids (in about one third of people)
- A milky white fluid in the anterior chamber of the eye (hypopyon)
- The cornea may appear white and cloudy
The signs of endophthalmitis after surgery or injury can vary depending on when it develops.
Symptoms of endophthalmitis that starts within days or up to two weeks after surgery tend to include:
- Sudden worsening of vision
- Eye pain that keeps getting worse
- Redness
- Discharge
- White fluid in the eye (hypopyon)
Symptoms can be different and milder when endophthalmitis develops later after surgery. This is known as delayed postoperative endophthalmitis. Symptoms can be:
- Slower loss of vision or blurred vision
- Gradually developing redness in the eye
- The eyes may not be painful, or eye pain can be mild
- Sensitivity to bright lights
Endophthalmitis treatment
Prompt treatment for endophthalmitis can make all the difference. The type of medicine you have depends on whether you have a bacterial or fungal infection. For either, the first line of treatment is usually a direct injection of medication into the eye, using a tiny needle. In severe cases, you may need a short hospital stay for IV antibiotics and monitoring.
You may be given corticosteroid medicine to reduce swelling, and eye drops or tablets to take at home.
Some people need further treatment, particularly if their vision is very poor. This may involve vitrectomy surgery to remove the infected vitreous gel from the eye.
You will have frequent follow-up appointments to monitor your recovery and vision after endophthalmitis.
Causes of endophthalmitis
Endophthalmitis happens when the internal fluids (vitreous or aqueous) or tissues of the eye become infected and inflamed. It's called exogenous endophthalmitis when the infection is caused by something outside the body (like a foreign body or surgery). When the source of infection comes from elsewhere in the body, it's known as endogenous endophthalmitis.
Endophthalmitis diagnosis
An ophthalmologist will carefully examine your eyes to diagnose endophthalmitis. Tell them if you've had any eye procedures or injury. Tests to diagnose endophthalmitis can include:
- A visual acuity test to check your vision.
- A detailed look at your eyes, using a slit-lamp.
- If needed, an ultrasound to check for intraocular foreign bodies (inside the eye) after an injury.
- A biopsy of vitreous fluid (known as a vitreous tap) to confirm the infection type.
Preventing endophthalmitis
There are some steps you can take to lower the risk of getting endophthalmitis. Use protective eyewear such as goggles or eye shields when doing activities like DIY and contact sports. If you've had eye surgery or eye injections, follow your doctor's aftercare instructions, for example, washing your hands before taking eyedrops.
When to get medical advice
If you're experiencing symptoms that could mean the start of endophthalmitis, especially if you've recently had eye surgery or eye injections, see an eye doctor immediately. You can search for local NHS eye accident and emergency services.
Don't put it off, because if you do have endophthalmitis, the sooner treatment is started, the better chance of success.
Regular eye tests, at least every two years, are important for everyone. Your optician will check your eye health, especially if you have an eye condition or previous eye injury. If you have a family history of eye conditions, you may need more frequent eye exams.
Living with endophthalmitis
The symptoms of endophthalmitis, such as eye pain and declining vision, can be unpleasant and worrying. With treatment, the discomfort should ease, and your vision has a chance to recover.
Although rare, some people have lasting vision loss. If this affects you, it's natural to worry about how you'll cope. There's lots of support available to help you adjust practically, and talking to others in a similar situation can help you deal with the emotional side of vision loss.
Frequently asked questions
Medically reviewed by: The Royal College of Ophthalmologists on 18/10/2022
Edited by: Nick Astbury FRCS FRCOphth FRCP
Clinical Associate Professor
LSHTM
The Royal College of Ophthalmologists champions excellence in the practice of ophthalmology and is the only professional membership body for medically qualified ophthalmologists. The RCOphth is unable to offer direct advice to patients. If you’re concerned about the health of your eyes, you should seek medical advice from your GP, optometrist or ophthalmologist.