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Quick detection essential for late-onset endophthalmitis
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Late-onset endophthalmitis, though rare, is a potentially devastating complication that can be easy to miss. According to experienced clinicians, the best way to detect it is to always be vigilant for its signs and symptoms, know how to treat it and have good communication with your comanaging partner.
Most late-onset endophthalmitis is diagnosed around 7 to 10 days postoperatively; suspicion should be raised if an increase in cell and flare is observed in the anterior chamber, according to Primary Care Optometry News Editorial Board member Paul M. Karpecki, OD, FAAO.
“Cell and flare is typically present at day 1, then subsides over the next 1 to 3 weeks. If it is increasing at the 1-week postop visit, that could signal potential endophthalmitis,” he said in an interview. “And along with an increase in cell and flare, there can also be a hypopyon present.”
Paul M. Karpecki
“Of particular concern,” PCON Editorial Board member John A. Hovanesian, MD, FACS, said, “would be the presence of developing vitreous cells, which, in the postoperative setting, would be highly suggestive of an intracameral infection.”
“That’s why it’s important to have good communication between the surgeon and the comanaging optometrist,” Karpecki said. “If the optometrist is seeing the day 1 and week 1 visit, he or she will note the increase; but if instead the surgeon is seeing the day 1 visit, he or she needs to communicate the finding to the comanaging optometrist, who will see the 1 week visit.”
John A.
Hovanesian
It is also important to note any increase in patient-reported pain or discomfort, he said.
“It’s not typical for patients to have significant pain after cataract surgery with today’s small incision procedures, so pain could be a red flag, and, certainly, an increase in pain would warrant seeing the patient that day,” Karpecki said.
A decrease in vision would also be a red flag, he added.
“Vision usually improves with time after the cataract procedure,” Karpecki said. “A patient that calls the office mentioning a decrease in visual acuity needs to be seen immediately. Pain and drop in vision are hallmark signs of endophthalmitis.”
A sign of late-onset endophthalmitis is an increase in cells and flare at the 1-week postoperative visit.
Image: Karpecki PM
“The bottom line,” Hovanesian said, “is that if you suspect endophthalmitis, you should refer. Time is of the essence in getting patients treated for this condition. It’s far better to have a false alarm referral than a missed diagnosis.”
Karpecki agreed and added that the patient can be referred back to the ophthalmologist who performed the cataract surgery or directly to the retina specialist — where he or she will be treated with a vitrectomy and injection of antibiotics into the eye — but not before the surgeon is consulted. – by Daniel R. Morgan
Good communication between the comanaging clinicians will expedite treatment and resolution of the condition.
For more information:
Paul M. Karpecki, OD, FAAO, a member of the PCON Editorial Board, can be reached at Koffler Vision Group, Eagle Creek Medical Plaza, 120 N. Eagle Creek Dr., Suite 431, Lexington, KY 40509; (859) 263-4631; paul@karpecki.com.