Diagnostics

• Indicated in all patients with endophthalmitis.

• Cornea: edematous/hazy

• Chambers containing aqueous humor: hazy; hypopyon

• Vitreous chamber: inflammation (cells and protein); white and fluffy infiltrates (snowball appearance) in fungal endophthalmitis

• Indicated in all patients with endophthalmitis.

• Loss of the red reflex (due to chorioretinitis)

• Roth spots may be seen in patients with endogenous endophthalmitis due to infective endocarditis, and occasionally in fungal endophthalmitis.

• Bacterial endophthalmitis: nonvisualization of retinal vessels

• Fungal endophthalmitis: creamy white retinal nodules

Ultrasound of the eye (B-scan)

• Indicated if the vitreous cannot be seen on slit lamp examination (e.g., due to a hazy cornea/aqueous chamber)

• Findings: hyperechogenicity of the vitreous (due to inflammation), thickened chorioretinal membrane

Gram-stain and culture of aqueous and/or vitreous humor

• The aqueous and/or vitreous humor can be extracted through a fine needle and cultured.

• Indicated in doubtful cases

Workup for primary source of infection

• For patients with endogenous endophthalmitis

• Blood cultures: should be done in all patients with endogenous endophthalmitis

• When an infectious source is unknown, the following tests are indicated:

  • Urine culture to rule out UTI

  • ECHO to rule out infective endocarditis (suspect in IV drug abusers or patients with prosthetic heart valves)

  • Abdominal USG to rule out liver abscess (suspect in patients with DM, hepatobiliary disease).