Traumatic Endophthalmitis

Posttraumatic infectious endophthalmitis, a devastating complication of open globe injury, is one of the most important urgencies in ophthalmology. The risk increases in the presence of an intraocular foreign body (IOFB) as well as delayed primary wound repair and in rural trauma associated with soil. Primary intraocular lens (IOL) implantation should be avoided during repair. Prevention is the most important step of the treatment by early primary repair and early vitreoretinal surgery in the presence of IOFB. Pain unproportionate with the injury may be the earliest sign of posttraumatic endophthalmitis. In such eyes, intravitreal antibiotics may be used as a prophylaxis during primary repair. Gram-positive organisms are the most common pathogens, but there is a high incidence of Bacillus species, especially in the presence of IOFB. An immediate intravitreal ceftazidime and vancomycin are the first choice for treatment supported by systemic fourth-generation fluoroquinolones. Visual prognosis is usually poor. Vitreoretinal surgery should be planned as soon as possible, and a limited vitrectomy should be performed if the retina is attached, inflamed, and fragile. Silicone oil is a good choice as a tamponade, which may help control the infection.