**Types of Endophthalmitis:**

Endophthalmitis is a severe inflammation of the interior of

the eye, involving the vitreous humor and/or aqueous humor.
It can be broadly classified into two types: exogenous and
endogenous.

1. **Exogenous Endophthalmitis:** This type occurs due to

the direct introduction of infectious agents into the eye.
Common causes include post-surgical complications,
trauma,or penetrating injuries where bacteria enter the eye
through external sources.

2. **Endogenous Endophthalmitis:** Endogenous

endophthalmitis results from the hematogenous spread of
microorganisms from a distant site in the body to the eye. It
often occurs in immunocompromised individuals and is
associated with systemic infections like bacterial
endocarditis or septicemia.

**Clinical Features of Acute Bacterial Endophthalmitis:**

Acute bacterial endophthalmitis is a sight-threatening

emergency that requires immediate medical attention. Its
clinical presentation includes:

1. **Sudden Decrease in Vision:** Patients may experience a

rapid decline in vision, often within hours.
2. **Severe Eye Pain:** Accompanied by redness, swelling,
and a feeling of pressure in the eye.
3. **Hypopyon:** The presence of pus in the anterior
chamber of the eye, causing the formation of a visible layer
of white blood cells.
4. **Conjunctival Injection:** Redness of the conjunctiva due
to inflammation.
5. **Hazy Cornea:** The cornea becomes cloudy due to
inflammation and cellular infiltration.
6.**Photophobia;** Sensitivity to light, making it
uncomfortable for the patient to open their eyes in bright
light.
7. **Positive Seidel Test:** Leakage of aqueous humor from
the wound site when tested with fluorescein dye, indicating a
perforation.
**Treatment of Acute Bacterial Endophthalmitis:**

1. **Immediate Hospitalization:** Patients suspected of

cute bacterial endophthalmitis need urgent hospitalization
and ophthalmic consultation.

2. **Vitreous Tap and Culture:** A sample of vitreous humor

is collected through a vitreous tap for microbiological
analysis to identify the causative organism. This guides
targeted antibiotic therapy.
3. **Broad-Spectrum Intravenous Antibiotics:** Empirical
intravenous antibiotics are administered immediately to
cover a wide range of bacteria until the culture and sensitivity
results are available.

4.**|ntravitreal Antibiotics:** Intravitreal injection of

antibiotics directly into the eye is performed to achieve high
drug concentrations at the infection site. Commonly used
antibiotics include vancomycin and ceftazidime.

5. **Corticosteroids:** In some cases, intravitreal

corticosteroids may be used to reduce inflammation;
however, this decision is made on a case-by-case basis.

6. **Surgical Intervention:** In severe cases or when there is

a lack of improvement with medical treatment, vitrectomy
(removal of vitreous humor) may be necessary to remove the
infected material and improve the penetration of antibiotics
into the eye.

7. **Close Monitoring:** Patients are closely monitored for

signs of improvement or worsening. Adjustments in
antibiotic therapy may be made based on culture results and
clinical response.