Posttraumatic endophthalmitis. Causative organisms, treatment, and prevention.

BACKGROUND: Posttraumatic endophthalmitis is a rare complication of penetrating eye injuries that results in blindness in potentially salvageable eyes.

METHODS: 36 cases of posttraumatic endophthalmitis were evaluated retrospectively to determine which factors were associated with visual loss. All cases were treated with intravenous and intraocular antibiotics. Pars plana vitrectomy was performed in 15 (41.7%) cases as an adjunct to treatment.

RESULTS: Patients ranged in age from 18 months to 83 years, and included 30 men (83%) and 6 women (17%). Intraocular foreign bodies were present in 6 patients (16.7%), 9 (25%) had corneal lacerations, 13 (36.1%) had corneoscleral or scleral lacerations, and 8 (22.2%) had ocular trauma of unknown type. Of the 36 eyes, 21 (58.3%) had positive culture results, and 10 of these (27.8%) had multiple organisms. The most common isolates were Staphylococcus species (26.5%), Streptococcus species (20.6%), and Bacillus species (14.7%). In 4 cases the diagnosis was made 6 or more years after injury. Final visual acuity was 20/200 in 8 eyes (22.2%) and 20/300 in 1 eye. In 17 cases (47.2%), the eye was salvaged but visual acuity was 5/200 or worse, and 10 eyes (27.8%) were lost to enucleation or phthisis bulbi.

CONCLUSION: Prompt diagnosis and early treatment with intraocular and systemic antibiotics are important in the successful management of posttraumatic endophthalmitis. The use of pars plana vitrectomy was associated with a good visual outcome when used in select cases.