Enucleation Following Endophthalmitis – Case Report

Abstract BACKGROUND Endophthalmitis is an inflammation of both the anterior and posterior chamber (1). It can be classified into infectious and non-infectious. Infectious endophthalmitis is a bacterial or fungal infection inside the eye involving the vitreous and/or aqueous humor (2). It occurs following the exudation of the vitrous cavity (3) which can be further classified into exogenous (post-operative, post-traumatic) or endogenous. Most cases of endophthalmitis exogenous and occur after trauma to the eye. Post traumatic infectious endophthalmitis accounts for approximately 25-31% of patients among those with infectious endophthalmitis (4,5). Endogenous endophthalmitis on the other hand, refers to a blood-borne metastatic infection from the primary inoculation site secondary to a bacterial or fungal pathology (6). CASE REPORT A Caucasian patient in his 50’s with no relevant past medical history was admitted to the Intensive Care Unit (ICU) following a motor vehicle collision. During this period, it was noted that the patient developed a rash over his right eye. There was no trauma to the eye, no systemic signs of infection and no subjective visual signs as the patient was sedated. Computed tomography scanning (CT) revealed right orbital cellulitis with probable endophthalmitis, and lens dislocation as seen in Figure 1. The early lens dislocation was a poor prognostic sign, and despite surgical intervention and systemic and intravitreal antimicrobials, the patient’s cornea perforated, requiring subsequent evisceration of the right eye. CONCLUSIONS Endophthalmitis is a serious complication of trauma, surgical procedures, and septicaemia. It can lead to evisceration of the eye if not detected and treated early. The main objectives in endophthalmitis treatment are to eradicate or control infection with appropriate antibiotics, manage the inflammation with potent anti-inflammatories such as corticosteroids; and to offer supportive therapy such as eye care, reducing intraocular pressure and oedema.