Sterile Endophthalmitis

Post-injection sterile endophthalmitis is an acute intraocular inflammation of the vitreous cavity that resolves without the need of intravitreal antibiotics and/or vitreoretinal surgery. Differentiating between infectious and sterile endopthalmitis is often difficult and no particular sign or symptom makes the diagnosis but rather the whole clinical picture must be considered. Minimizing infection risk is accomplished through well-described sterile procedure. The differential includes infectious ednopthalmitis, sterile endophthalmitis and pseudo-endophthalmitis. Infectious etiologies include coagulase-negative Staphylococcus and Streptococcus species. Non-infectious etiologies remain unknown but are thought to be similar to TASS in that it is a host immunogenic response to sterilely packaged items. Workup includes a careful history and exam. An ultrasound that demonstrates vitreous membrane formation is indicative of an infectious etiology but the lack thereof does not rule out infection. Vitreous tap should be considered if one is concerned for infection. Prognosis is dependent on etiology. Cases of sterile endophthalmitis can be managed with topical steroids and vision generally returns to baseline. Infectious endophthalmitis is initially managed with broad-spectrum intravitreal antibiotics, additionally a vitrectomy may be indicated in more severe cases. 

Presentation Date: 03/22/2018

Issue Date: 08/01/2020