Managing an outbreak of postoperative endophthalmitis

  • 16 Feb 2022
  • RCOphth Quality and Safety Group

This guidance document has been updated to reflect more recent peer-reviewed publications and the scope has been widened to cover all ophthalmic surgery, intravitreal injections, and devices implanted in the eye as part of ophthalmology treatment

Acute endophthalmitis is a severe intraocular inflammation presumed to be due to the entry of microbes into the eye during the perioperative period. It is identified usually in the first two weeks after surgery and presents as a red painful eye with severe anterior uveitis, often with fibrin and hypopyon, and vitritis. It is not always culture positive. It is one of the most serious postoperative complications of intraocular procedures and, despite treatment, often results in a very poor visual outcome. The incidence in the developed world is low, approximately 0.1-0.08%, with an incidence in the UK (as determined by BOSU in 20045) of 0.14% after cataract surgery and approximately 0.02-0.06% after intravitreal injections.

The aim of this document is to provide advice on the identification and management of an outbreak of post ophthalmic procedure (post-op) endophthalmitis. The guidance will concentrate particularly on cataract surgery, but the principles and much of the detail are applicable to other intraocular procedures including intravitreal injections. As much as possible is based on published evidence but, in the absence of published high-quality evidence for many aspects, an expert consensus has been used to make recommendations.