Endophthalmitis: Treatment, Symptoms, Causes, and More

If you’ve never heard of endophthalmitis, congratulationsyou’ve successfully avoided one of the eye world’s
biggest emergencies. If you have heard of it because your doctor mentioned it, you had surgery, got an eye injection,
or had an eye injury… let’s talk. Endophthalmitis is a serious infection (and intense inflammation) inside the eye,
and it can threaten vision fast. This is not a “I’ll see how it feels tomorrow” situation. It’s a “call the eye doctor now”
situation.

In this guide, you’ll learn what endophthalmitis is, the symptoms to watch for, what causes it, how it’s diagnosed, and how it’s
treatedplus practical, real-world “what it’s like” experiences at the end.

What Is Endophthalmitis?

Endophthalmitis is a severe inflammation of the eye’s internal fluids (the vitreous and/or aqueous humor), usually caused by a
bacterial or fungal infection. Think of it as an intraocular infectiona place where germs absolutely do not
belong. Because the inside of the eye is delicate (and not easily “flushed out”), infection can quickly damage structures needed
for vision.

Symptoms of Endophthalmitis

Symptoms can vary, but the classic combo is: eye pain + redness + sudden vision changes. Some people also notice
floaters (specks or cobwebs drifting across vision) and photophobia (light sensitivity).

Common symptoms

• Worsening eye pain (especially after surgery or an injection)
• Redness that’s increasing, not fading
• Blurred or decreased vision (sometimes dramatic)
• Floaters that are new or suddenly worse
• Light sensitivity
• Swollen eyelids or a “heavy” feeling around the eye

“But I just had eye surgery/injectionsome discomfort is normal, right?”

Yes, mild irritation can be normal after procedures. The difference is the trend: endophthalmitis symptoms typically
get worse, not better, and vision often drops. Retina specialists also warn to call if pain, floaters, light sensitivity, or
decreased vision ramp up after an intravitreal injection.

One more tricky detail: not all post-injection inflammation is infectious. There are “sterile” inflammatory reactions that can
mimic infection, but they still require urgent evaluation because the consequences of missing a true infection are enormous.

Types of Endophthalmitis

Exogenous vs. endogenous

Most cases are exogenous, meaning germs enter the eye from the outsidemost commonly after eye surgery,
intravitreal injections, trauma, or severe corneal infection. Endogenous endophthalmitis is less common and
happens when infection spreads through the bloodstream from another site in the body and “seeds” the eye.

Acute vs. chronic

Acute endophthalmitis tends to appear quicklyoften within days of surgery, injection, or injury. Chronic
endophthalmitis can smolder for weeks to months with more subtle symptoms, sometimes associated with certain organisms
or implanted devices (like an intraocular lens).

Causes and Risk Factors

Endophthalmitis is caused by microorganismsmost often bacteria, sometimes fungitriggering intense intraocular inflammation.
The organisms and risk profile depend on the route of infection.

Common causes (exogenous)

• Eye surgery (especially cataract surgery, but also others)
• Intravitreal injections (used for conditions like macular degeneration or diabetic eye disease)
• Open-globe trauma (penetrating eye injuries)
• Severe corneal infection that spreads inward

These routes are repeatedly cited as the major ways infection is introduced into the eye.

Common causes (endogenous)

Endogenous endophthalmitis usually starts with a systemic infectionbacteria or fungi in the bloodespecially in people with
certain risk factors:

• Diabetes
• Immunosuppression (from medications or illness)
• Indwelling catheters or recent hospitalization
• Bloodstream infections like candidemia (Candida in the blood)
• Endocarditis or other deep infections

Candida bloodstream infection is a well-known pathway for endogenous fungal endophthalmitis, and major infectious-disease guidance
discusses eye evaluation in candidemia (with some differences between organizations).

Which germs cause it?

The organism depends on the scenario. After surgery or injections, organisms from the skin and ocular surface often play a role
(for example, various staphylococcal and streptococcal species). Trauma raises concern for more aggressive pathogens depending on
the injury environment. Endogenous cases may involve bacteria from systemic sources or fungi such as Candida.

How Endophthalmitis Is Diagnosed

Diagnosis is primarily clinicalbased on symptoms and an urgent eye exambut microbiology testing helps guide targeted treatment.
Eye specialists may look for findings such as significant inflammation in the anterior chamber, possible hypopyon (layering of
white blood cells), and vitritis (inflammation in the vitreous).

Tests you may hear about

• Slit-lamp and dilated eye exam to assess internal inflammation
• Vitreous or aqueous tap (small sample from inside the eye) for Gram stain and culture
• B-scan ultrasound if the view to the back of the eye is blocked
• Blood/urine cultures when endogenous endophthalmitis is suspected

Professional references emphasize microbiologic testing and systemic cultures when endogenous infection is suspected.

Treatment: What Actually Happens (and Why It’s Urgent)

Endophthalmitis is treated as an emergency because delays can lead to irreversible vision losseven within hours in extreme cases.
The goal is to stop infection quickly, reduce inflammation, and preserve the eye and vision as much as possible.

Intravitreal antibiotics

The backbone of therapy for suspected bacterial endophthalmitis is often intravitreal antibioticsmedication
injected directly into the eye so it reaches high concentrations where it’s needed most. Common empiric regimens in many protocols
include broad coverage for Gram-positive and Gram-negative bacteria (often referenced as vancomycin plus ceftazidime, with
alternatives in some cases).

Vitrectomy

Pars plana vitrectomy is a surgery that removes infected vitreous gel, lowers the microbial/inflammatory load,
and can improve the doctor’s ability to clear the infection and obtain samples. The landmark Endophthalmitis Vitrectomy Study
historically influenced when immediate vitrectomy is recommended (notably in very poor presenting vision such as light perception),
and modern practice still uses these principles while individualizing decisions.

Systemic therapy

Systemic (IV or oral) antibiotics or antifungals may be used depending on the type of endophthalmitis and the suspected source.
For endogenous cases, treating the underlying bloodstream infection is essential, and eye-directed therapy is often
combined with broader medical evaluation and infectious-disease management.

Antifungal treatment (when fungi are involved)

Fungal endophthalmitis may require intravitreal antifungals and systemic antifungals, particularly when the eye is involved due to
a bloodstream infection (like candidemia).

Steroids: helpful or harmful?

Steroids can reduce inflammation, but in infection, suppressing inflammation too early can be risky. Some protocols use
intraocular steroids as an adjunct; others are more cautious. In short: this is very case-specific, and it’s one reason treatment
decisions belong in a retina/ophthalmology officenot a group chat.

Recovery, Prognosis, and Complications

Outcomes depend on several factors: how quickly treatment starts, what organism is involved, how severe the infection is at
presentation, and whether there are complications (like retinal detachment). Unfortunately, endophthalmitis can lead to permanent
vision loss even with appropriate careanother reason speed matters.

What recovery can look like

• Frequent follow-ups (sometimes daily early on)
• Repeat injections or additional procedures if inflammation persists
• Vision that improves gradually over weeksor sometimes doesn’t return to baseline
• Temporary activity restrictions while the eye stabilizes

Prevention: How Doctors Try to Stop It Before It Starts

Because endophthalmitis is rare but high-stakes, prevention is a big deal. Standard prevention focuses on reducing bacteria on the
ocular surface and maintaining strict sterile technique during surgery and intravitreal injections.

Key prevention strategies

• Antiseptic prep (commonly povidone-iodine) before injections and surgery
• Careful draping/lid control and sterile instruments
• Managing eyelid disease (like blepharitis) when appropriate

For intravitreal injections specifically, strong evidence indicates that post-injection topical antibiotic drops do not
reduce endophthalmitis risk, and repeated antibiotic use may contribute to resistant organismsso many modern protocols
avoid routine topical antibiotics.

If a patient can’t tolerate povidone-iodine, other antiseptics may be considered in selected settings, and ophthalmology literature
continues to evaluate options like chlorhexidine for prevention and comfort.

When to Seek Emergency Care

If you recently had eye surgery, an intravitreal injection, or an eye injury and you develop worsening pain,
increasing redness, new floaters, light sensitivity, or decreased
vision, treat it as urgent. The safest rule is: if it feels “too dramatic to ignore,” it probably is.

Questions to ask your eye team (because you’re allowed to be politely nosy)

• Do my symptoms fit endophthalmitis, sterile inflammation, or something else?
• Are you taking samples for culture? When will results return?
• What treatments am I getting today (intravitreal meds, surgery, systemic meds)?
• What warning signs mean I should call you tonight?
• What does recovery typically look like for my situation?

FAQ

Is endophthalmitis contagious?

Nonot in the usual “catch it from someone” way. It’s typically related to surgery, injections, injury, or a bloodstream infection.

How soon can it happen after cataract surgery or injections?

Acute cases often show up within days after surgery or injections, but timing can vary depending on organism and circumstance.
Any sudden worsening symptoms after a procedure deserve immediate attention.

Can it happen without much pain?

Yes. While pain is common, some casesespecially certain post-injection presentationsmay have more prominent vision loss or
inflammation than pain. If your vision suddenly drops, don’t let “it doesn’t hurt that bad” talk you into waiting.

Real-World Experiences: What People Commonly Describe (Extra )

Endophthalmitis is one of those conditions where the experience is often described in the same emotional vocabulary“sudden,”
“scary,” “I knew something wasn’t right.” And that makes sense: most eye procedures are outpatient, and people expect mild
scratchiness, not a plot twist.

1) The post-procedure “this is not normal” moment

A common story after cataract surgery or an intravitreal injection goes like this: the first few hours are fine, maybe a little
gritty or watery. Then pain ramps up, redness spreads, and vision gets foggylike someone smeared petroleum jelly on the inside of
the windshield. People often describe floaters multiplying quickly or light becoming uncomfortably bright. The turning point is
realizing the symptoms are escalating rather than settling down. That “worse instead of better” pattern is exactly why clinicians
emphasize calling immediately with worsening pain or vision changes.

2) The urgent clinic visit (and the very fast decision-making)

Another common experience is how quickly the eye team moves. Endophthalmitis workups and treatment don’t usually include long
waiting-room marathons and a “let’s recheck in two weeks.” Instead, patients often describe a rapid exam, bright lights, lots of
focused conversation, and thenif suspectedimmediate steps to treat and collect samples. The speed can feel intense, but it’s
purposeful: delaying treatment can risk permanent damage.

3) The “inside-the-eye injection” fear (and the relief afterward)

Many people are understandably nervous when they hear “we need to inject medicine into the eye.” The reality is that ophthalmology
teams use numbing drops and sterile technique, and most patients report pressure more than sharp pain. The emotional relief often
comes afterwardknowing treatment has started. Intravitreal antibiotics are a standard approach because they deliver high
medication levels right where the infection is.

4) The recovery roller coaster

Recovery experiences vary widely. Some people describe day-to-day improvement: less pain, decreasing redness, and vision slowly
clearing over weeks. Others experience a more uneven pathvision that improves and then plateaus, or additional procedures such as
vitrectomy if the infection is severe or not responding. A practical theme patients mention is the frequency of follow-ups and the
importance of sticking to the plan exactly (drops, appointments, activity restrictions). Prognosis depends on factors like the
organism involved and how early treatment begins, which is why early reporting of symptoms is so heavily emphasized.

5) The “I wish I’d known this” tips people share

• Have a ride plan. If anything goes wrong after a procedure, you may not be able to drive safely.
• Take symptom changes seriously. Sudden decreased vision is a medical emergency even if the pain is mild.
• Don’t self-treat with leftover drops. Using old antibiotics or random drops can muddy the picture and delay proper care.
• Ask for clear red-flag instructions. After any eye procedure, know exactly what signs mean “call now.”

If there’s one takeaway that shows up again and again in patient stories and professional guidance, it’s this:
act fast. Your eye is a masterpiece of tiny, irreplaceable parts. When infection gets inside, it’s not being
dramaticit’s being dangerous.

Conclusion

Endophthalmitis is rare, but when it happens, it’s urgent. Watch for worsening eye pain, redness, floaters, light sensitivity, and
sudden vision changesespecially after eye surgery, intravitreal injections, or injury. Diagnosis is rapid and clinical, often
supported by cultures. Treatment typically involves intravitreal antibiotics and sometimes vitrectomy, with systemic therapy when
the infection is endogenous or fungal. Prevention focuses on antiseptic prep and sterile technique, and routine topical antibiotics
after injections generally don’t lower risk. If symptoms spike, don’t waitcall an eye specialist or seek emergency care.