**4. Clinical presentation**

Clinical presentation of the disease depends on the virulence and toxin production of the infecting pathogen, the mechanism of introduction into the eye, how quickly treatment is initiated and the patient's age [10]. Symptoms of endophthalmitis range from a relatively painless anterior chamber inflammation, such as that typically caused by *Staphylococcus epidermidis* to an indolent and protracted intra-ocular infection caused by *P. acnes*, to an explosive ocular and periorbital infection caused by *B. cereus* [10]. The clinical presentations of various endophthalmitis are depicted in Table 4.


**Table 4.** Clinical presentation of various endophthalmitis

**Source of infection Causes Incidence rate**

1. Post-traumatic 1–17% Endogenous endophthalmitis 2–8%

**Classification** Causative agents

**Table 2.** Incidence rates of different types of endophthalmitis

**Exogenous 1. Post-operative endophthalmitis**

**of surgery)**

**Delayed or chronic (after 6 weeks**

**Table 3.** Etiological agents of different types of endophthalmitis

**4. Clinical presentation**

**Source of infection**

26 Advances in Common Eye Infections

Vitrectomy 0.05–0.14% Episcleral surgery 0.01%

**Acute (within 6 weeks of surgery)**Coagulase-negative staphylococci (Most common "/>60%),

spp. and *Fusarium* spp.

**2. Post-traumatic endophthalmitis**Staphylococci (most common), *Bacillus cereus, Streptococci, P.*

**Endogenous Endogenous endophthalmitis** Fungi like *Candida spp. (Candida albicans, C. glabrata, C. tropicalis,*

Clinical presentation of the disease depends on the virulence and toxin production of the infecting pathogen, the mechanism of introduction into the eye, how quickly treatment is initiated and the patient's age [10]. Symptoms of endophthalmitis range from a relatively

and *Fusarium* spp.

*meningitidis* and *Klebsiella* spp.

*aeruginosa* and polymicrobial infections.

enterococci.

*Staphylococcus aureus*, viridans group streptococci, and

Gram-negative organisms like *Pseudomonas aeruginosa* [2]. Fungi like *Candida* spp. (especially *C. parapsilosis*), *Aspergillus*

*Propionibacterium acne* (most common)*, Streptococcus* spp., coagulase negative staphylococci (*S. epidermidis*), filamentous bacteria (including *Actinomyces and Nocardia* sp.), *Hemophilus influenzae*, non-tuberculous mycobacteria (*M. abscessus, M. chelonae*, etc.) and *candida* spp. (*Candida parapsilosis*).

Filamentous fungi, especially *Aspergillus* sp. and *Fusarium* sp.

*C. dubliniensis, C. krusei), Aspergillus* sp. (*A. fumigatus, A. flavus*)

Gram-positive bacteria include *S. aureus*, *B. cereus* and Gramnegative organisms, including *Escherichia coli*, *Neisseria*

Rarely, protozoa like Microsporidia and Amoebae.

Strabismus surgery Very rare (1 in 30,000)

**Figure 1.** Intense conjunctival congestion with corneal edema and hypopyon

**Figure 2.** Endophthalmitis affecting the cornea

**Figure 3.** White bleb with intense conjunctival injection suggestive of bleb-associated endophthalmitis

**Figure 4.** Post-traumatic endophthalmitis caused by *Bacillus cereus* showing prominent conjunctival congestion, corneal ring infiltrate and dense hypopyon
