An endogenous
endophthalmitis is a severe, potentially blinding intraocular
infection due to haematogenous spread of germs. In Europe, gram-positive bacteria and Candida albicans are common causative organisms. Compared to post-operative cases of
endophthalmitis, endogenous
endophthalmitis is relatively rare, accounting for 2-8% of all
endophthalmitis cases. Most patients suffer from an underlying disease causing some kind of immunodeficiency. Other predisposing factors are long-term
therapy in intensive-care units (ICU), intravenous
catheters, iatrogenic immunosuppression or
intravenous drug abuse. Final visual acuity strongly depends on the time needed for the correct diagnosis, the infectious agent and the selection of adequate treatment. Identification of the infectious agent by vitreous biopsy and blood cultures enables the ophthalmologist to choose a specific
antibiotic treatment.
Therapy consists of topical, intravitreal and systemic
antibiotics or antimycotics often in combination with
steroids and pars plana
vitrectomy. As many of the patients with endogenous
endophthalmitis are initially misdiagnosed (e. g.
uveitis), it is important to consider this disease in the presence of suspicious symptoms.