Acute Bacterial Endophthalmitis Post-Intravitreal Injection: Emergency Signs Requiring Retinal Salvage Within Hours

Acute bacterial endophthalmitis is the most severe emergency following intravitreal injection. It presents with severe, escalating pain and a sudden, sharp decrease in vision. Dr. Mahmoud Hassan highlights the critical importance of immediate vitreous lavage with antibiotics.

Acute Bacterial Contamination After Eye Injection: Emergency Signs Requiring Retinal Salvage Within Hours

Intravitreal injection is a critically important medical procedure used to treat a wide range of serious retinal diseases such as diabetic retinopathy, macular edema, retinal vein occlusion, and posterior uveitis. While this technique has revolutionized vision preservation and restoration, like any medical procedure, it carries potential risks. Perhaps the most prominent and serious of these is acute bacterial contamination, medically known as endophthalmitis.

Neglecting the early warning signs of this inflammation can lead to dire consequences, including permanent vision loss within a few hours. Therefore, awareness of these signs and a rapid response are key to saving the retina. In this article, Dr. Mahmoud Hassan, a vitreoretinal surgeon and a key contributor to Al Mashreq Eye Center in Cairo, sheds light on this emergency condition and how to manage it.

What is Endophthalmitis?

Endophthalmitis is a bacterial or fungal infection that affects the inner layers of the eye, including the vitreous humor and retina. This inflammation often occurs as a rare complication of eye injections, where bacteria can enter the eye during the injection procedure if strict sterile procedures are not meticulously followed. In very rare cases, the inflammation may occur after other eye surgeries, such as cataract surgeries.

This condition requires immediate medical intervention, as bacteria multiply rapidly inside the eye, causing severe inflammation and destruction of sensitive visual tissues, especially the retina. The longer treatment is delayed, the greater the likelihood of permanent and irreparable damage.

Emergency Signs Requiring Immediate Salvage

Patients who have undergone an eye injection should be fully aware of signs that may indicate the onset of endophthalmitis. These signs often appear within a few days after the injection, and in some cases, up to one or two weeks. Scientifically, the main symptoms to watch for include:

• Severe and sudden eye pain: This pain differs from any minor discomfort the patient might experience after the injection. It is a deep, throbbing, and constantly increasing pain that does not respond to ordinary painkillers.
• Acute and sudden decrease in visual acuity: This is not just a slight blurriness, but a noticeable and rapid decline in the ability to see. The patient may feel that vision has become significantly dim or blurred.
• Severe redness in the white of the eye: Eye redness can be normal after an injection, but in the case of inflammation, the redness is severe and often accompanied by pain.
• Extreme sensitivity to light (photophobia): The patient becomes unable to tolerate bright light; even normal light can cause severe discomfort.
• Swelling of the eyelid or around the eye: Inflammation may be accompanied by swelling in the tissues surrounding the eye.
• Purulent discharge from the eye: In some advanced cases, yellow or green discharge from the eye may be noticed.

It is worth noting that these symptoms can sometimes resemble other less serious conditions, but their severity and rapid progression distinguish endophthalmitis as an emergency condition requiring immediate evaluation by a specialized ophthalmologist.

Why is Endophthalmitis an Emergency?

The primary reason endophthalmitis is considered an emergency is the rapid destruction of sensitive tissues within the eye. Bacteria release toxins and cause chronic inflammation that leads to:

• Damage to light-sensitive retinal cells.
• Pus formation within the vitreous humor, obstructing light passage to the retina.
• Increased intraocular pressure (IOP), which can lead to optic nerve damage.
• In severe cases, inflammation can lead to intraocular fibrosis, or even complete loss of the eye.

Therefore, rapid intervention is the only way to save whatever visual functions of the eye are salvageable. Every hour that passes without treatment increases the difficulty of restoring vision.

Diagnosis and Immediate Treatment at Al Mashreq Eye Center

If endophthalmitis is suspected, immediate referral to the nearest specialized medical center or equipped hospital is crucial. At Al Mashreq Eye Center, these cases are treated as a top priority. Diagnosis typically includes:

• A thorough eye examination using a slit lamp to assess the extent of inflammation.
• Fundus examination to evaluate the condition of the retina and vitreous humor.
• In some cases, a sample of vitreous fluid (vitreous tap) may be taken for laboratory analysis to identify the type of bacteria causing the infection, which helps guide appropriate antibiotic treatment.

Treatment, on the other hand, primarily depends on:

• Immediate intravitreal injection of antibiotics: High doses of potent antibiotics are injected directly into the vitreous humor to kill bacteria.
• Vitrectomy: In severe cases, the surgeon may perform a partial or complete removal of the infected vitreous humor, replacing it with a sterile solution or gas. This procedure, also known as vitrectomy, aims to remove as much bacteria and pus as possible, and improve antibiotic access to infected tissues. The estimated average cost of complex/tractional/retinal detachment vitrectomy surgery in Egypt for 2026 is approximately 50,000 EGP.
• Use of steroids: Steroid drops or injections may be used to control inflammation and reduce subsequent tissue damage.
• Intravenous antibiotic therapy: In some cases, the patient may need intravenous antibiotics to enhance treatment.

Prevention is Better Than Cure

Prevention of endophthalmitis largely depends on strict adherence to sterile standards during the injection procedure. The team at Al Mashreq Eye Center ensures the highest safety and hygiene standards are applied in every procedure, from sterilizing the skin around the eye, to using sterile instruments, to injection techniques that minimize the chance of microbial entry.

Furthermore, early patient awareness of warning signs and a rapid response play a crucial role in treatment success. Never hesitate to contact your doctor or go to the emergency room if you experience any of the mentioned symptoms after an eye injection.

Maintaining eye health requires constant vigilance and close cooperation between the patient and doctor. Always remember that early detection of any problem is half the solution. For more information on retinal diseases and their treatment, you can follow us.

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