Synopsis
Recognise suspected intraocular infection after procedures, trauma or bloodstream spread, and coordinate immediate ophthalmic sampling and treatment without waiting for microbiological confirmation.
- Exogenous infection enters through surgery, injection, injury or an infected ocular surface; endogenous infection reaches the eye through bloodstream spread.
- Reduced vision, pain, redness, lid swelling, hypopyon and vitritis are important findings, but absent pain or absent hypopyon does not exclude infection.
- Diagnosis is initially clinical and treatment must not wait for the result of a vitreous culture.
Key red flags
New or worsening visual loss with redness, photophobia or pain after an eye operation or intravitreal injection requires emergency eye assessment for possible endophthalmitis.
Investigation priorities
Establish visual compromise and the extent of intraocular inflammation.
Management branches
A patient develops suspicious pain, redness or visual reduction after ocular surgery, injection or penetrating injury.
- Contact emergency ophthalmology immediately, reporting the procedure, timing, acuity change and any systemic illness or immunosuppression.
- Arrange prompt examination and specialist sampling and treatment; do not substitute a trial of routine conjunctivitis drops or a delayed postoperative appointment.
Key medicines
Intravitreal vancomycinThe cited NHS postoperative bacterial protocol uses 1 mg in 0.1 mL by intravitreal injection urgently after sampling; further treatment is decided by ophthalmology.
Intravitreal ceftazidimeIn the same NHS protocol, administer 2.25 mg in 0.1 mL intravitreally alongside Gram-positive cover, using specialist preparation and individual review of further doses.