Endophthalmitis Overview

Published: March 20, 2020

cataract surgery

Almost 30 million Americans are affected by cataracts, and with the aging of the population, that number is projected to rise dramatically within the next few decades. The National Institutes of Health reports that more than half of all Americans will either have cataracts or will have had cataract surgery by the time they reach the age of 80. Most cataracts are caused by normal changes as a result of aging.[1]

The greatest increase in cataract surgery is between people aged 70-80, largely because aging baby boomers are staying in the workforce longer, desiring to be more active, placing more demands on their vision.[2] Cataract surgery is the most frequently performed surgery throughout the world, with an estimated 10 million surgeries completed each year. Most patients have improved vision after surgery with uncomplicated post-operative courses.[3]

Endophthalmitis, an infection of the fluids or tissues inside the eye, is a medical emergency that requires immediate medical treatment. It can cause blindness if not treated promptly.[4] The infection is an uncommon complication of cataract surgery. It is reported to occur at rates between 0.03 percent and 0.2 percent of all cataract surgeries.[5]

While all intraocular procedures have some risk of endophthalmitis, it is most commonly reported following cataract surgery and intravitreal injections, because of the large numbers of these procedures carried out globally. Prompt treatment is vital when endophthalmitis is diagnosed. “In order to achieve a rapid response, it is important to have an accessible protocol and an endophthalmitis kit at hand for all eye surgeons who see postoperative patients.”[6] 

Prevention of endophthalmitis begins well before surgery, with practitioners assuring that: the patient has been compliant with preoperative instructions, instruments are properly sterilized, and the preoperative surgical scrub has been completed. At the conclusion of surgery, the intracameral injection of the antibiotic cefuroxime has been shown to reduce the incidence of endophthalmitis.[7] Likewise, a clinical trial conducted in 2016 studying the effectiveness of an injection of moxifloxacin at the conclusion of surgery also showed a reduction in the incidence of endophthalmitis.[8]

Symptoms of endophthalmitis include eye pain, red eyes, discharge from the eyes, swollen eyelids and decreased vision.[9] Once diagnosed, the standard treatment for endophthalmitis is intravitreal antibiotics. Vancomycin is indicated for gram-positive coverage and ceftazidime or an aminoglycoside is indicated for gram negative coverage, according to an article in the Journal of Clinical Microbiology.[10] Between 70 and 80 percent of post-operative endophthalmitis is caused by coagulase-negative staphylococci, and when treated immediately, the prognosis for vision is good.[11]



[1] National Eye Institute, online article, Cataracts https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts

[2] Zagaria, Mary Ann E., U.S. Pharmacist Magazine, online article, Postoperative Endophthalmitis After Cataract Surgery https://www.uspharmacist.com/article/postoperative-endophthalmitis-after-cataract-surgery 

[3] George, Nicholas K, and Stewart, Michael W., Ophthalmology and Therapy, online article, The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258587/ 

[4] Mukamal, Reena, American Academy of Ophthalmology, online article, What is Endophthalmitis? https://www.aao.org/eye-health/diseases/what-is-endophthalmitis 

[5] George, Nicholas K, and Stewart, Michael W., Ophthalmology and Therapy, online article, The Routine Use of Intracameral Antibiotics to Prevent Endophthalmitis After Cataract Surgery: How Good is the Evidence? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258587/ 

[6] Niyadurupola, Nuwan, and Astbury, Nick, Community Eye Health Journal, U.S. National Library of Medicine, National Institutes of Health, online article, Postoperative Endophthalmitis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675262/

[7] Niyadurupola, Nuwan, and Astbury, Nick, Community Eye Health Journal, U.S. National Library of Medicine, National Institutes of Health, online article, Endophthalmitis: Controlling Infection Before and After Cataract Surgery https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377381/ 

[8] Singer, Jack A., online article, American Academy of Ophthalmology Journal, Intracameral Moxifloxacin After Routine Cataract Surgery Appears Safe https://www.aao.org/editors-choice/intracameral-moxifloxacin-after-routine-cataract-s 

[9] Mukamal, Reena, online article, American Academy of Ophthalmology, What is Endophthalmitis? https://www.aao.org/eye-health/diseases/what-is-endophthalmitis 

[10] Chen, Kuan-Jen, Chen, Tu-lu, Lai, Chi-Chun, and Sun, Ming-Hui, online article, Journal of Clinical Microbiology, Endophthalmitis: Antibacterial Activity of Precipitates of Vancomycin and Ceftazidime https://www.bing.com/search?q=vanomycin%20and%20ceftazidime%20and%20endophthalmitis&FORM=O1HV 

[11] Panda, Hemang K. MD, Dee McGee Eye Institute, University of Oklahoma College of Medicine, online article, Medscape, Postoperative Endophthalmitis https://emedicine.medscape.com/article/1201260-clinical