**21. Risk factors for endogenous endophthalmitis**

The most frequent risk factors for developing endogenous endophthalmitis include a prior history of diabetes mellitus, gastrointestinal disorders, hypertension, heart valve diseases, endocarditis, chronic obstructive lung disease, previous wound infection, meningitis, urina‐ ry tract infection, cystic fibrosis, immune-compromised status, splenectomy, organ trans‐ plantation and indwelling intravenous catheters, hepatic abscess, hemodialysis fistula, peritonitis and intravenous drug abuse (Figure 15). [71-78] Less frequent risk factors include, otitis media, dental infection, septic arthritis, abortion, pharyngitis and Hemoglobin SC dis‐ ease. [79-83] Other chronic diseases such as immunosuppressive status, HIV infection, can‐ cer, renal failure requiring dialysis, long-term use of broad-spectrum antibiotics, use of steroids and other immunosuppressive drugs, intravenous hyper-alimentation and indwel‐ ling intravenous catheters can lead potential pathogens access to the circulatory system and septicemia. History of chronic intravenous drug abuse, dental work, otitis media, soft-tissue infection including orbital cellulitis, and septic arthritis may lead to septicemia and endoge‐ nous endophthalmitis. [3, 79, 80]

**Figure 15.** External photograph of a diabetic patient who presented with loss of vision and painful ophthalmoplegia of his right eye along with fever and mental status changes (a). He was found to have severe panophthlamia of his right eye and ultrasonography revealed endophthalmitis (b). Computed tomography (coronal view) of his brain re‐ vealed evidence of septic emboli (c). Patient was treated with systemic antibiotics and right eye evisceration.
