**15. Endophthalmitis associated with microbial keratitis**

Many cases of infectious keratitis may progress to endophthalmitis if not treated early in the course of the diseases. [4, 9] Patient with underlying conditions may have propensity to poor response to non-aggressive treatment of infectious keratitis. Infections due to some pathogens may be very difficult to treat in patients with diabetes and other systemic condi‐ tions (Figure 9). Patients with chronic diseases, past history of corneal trauma, cataract sur‐ gery with lack of posterior capsule, having used topical corticosteroids, compromised immune system and trachoma have a poor visual prognosis. The bacterial species include Mycobacterium chelonae, Nocardia species, Staphylococcus aureus, streptococci and Coli‐ forms as well as Capnocytophaga. [3] In these patients, fungi are the most frequently report‐ ed organisms, of which Fusarium species are the commonest. Management in these patients may require early intervention that includes intra-vitreal antibiotics guided by the organ‐ isms seen on Gram and Ziehl-Neelsen stains of anterior chamber and vitreal taps.

**Figure 9.** External photograph of a 55-years-old male patient who presented with corneal ulcer which progressed to endophthalmitis despite aggressive medical management.
