Welcome to Review of Optometry's Practice Pearl of the Week series. Optometrist Paul Karpecki will provide you invaluable clinical information and management strategies for a host of ocular conditions—from dry eye and corneal infection to retinal artery occlusion and neuro-ophthalmic disease.

Endophthalmitis is one of the greatest fears for both clinicians and surgeons, because the condition can cause complete loss of the eye. Endophthalmitis most commonly develops after recent surgery, such as cataract removal or trabeculectomy. Although endophthalmitis can develop at any time following surgery, the average diagnosis is made in 9.2 days post-op.¹

Key Symptoms
Pain is the key symptom of endophthalmitis. Keep in mind, however, that many patients may describe feelings of extreme postoperative discomfort depending upon their individual tolerance levels. Nevertheless, significant pain generally indicates a risk for endophthalmitis—especially if the patient also complains of decreased visual acuity. In fact, if a patient who recently underwent ocular surgery complains of pain, immediately ask him or her, "Do you also notice any decrease in vision?"

Key Signs
Increased anterior chamber cell and flare is the key finding of endophthalmitis. An anterior chamber reaction is exceedingly common following cataract surgery; however, the presentation should subside gradually. If, however, you document significant cell and flare (grade 3 or higher) after seven to 10 days post-op—or the presentation's severity has increased since the last visit—you must promptly refer the patient to the surgeon and/or retina specialist.

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