Clinical presentation and prognostic factors in emergency department endophthalmitis: a 11-year retrospective study

Background: Endophthalmitis, a serious eye condition that poses a risk to vision and can quickly worsen, is considered a genuine urgent situation for the eyes. This research is concentrated on individuals with endophthalmitis who seek care in the emergency department (ED), with the objective of identifying the clinical signs and microbial properties that may increase the likelihood of needing evisceration. By doing so, the goal is to enhance the early detection and immediate management of this condition. Methods: This is a retrospective study conducted in the ED setting in a tertiary medical center in Northern Taiwan. Between January 2012 to December 2022, a total of 453 ED endophthalmitis patients were enrolled. Detailed chart reviews were done and the data collected included demographic characteristics, clinical symptoms, microbiology culture results, presenting visual acuity (VA), and the rate of evisceration. Results: There were 144 patients (31.8%) with endogenous endophthalmitis and 309 patients (68.2%) with exogenous endophthalmitis in the ED. The most common symptoms were blurry vision (94.3%) and red eye (88.7%). Blood culture was positive in 18.8% of cases, while vitreous or aqueous culture was positive in 59.6% of cases. The most commonly identified pathogens for endogenous and exogenous endophthalmitis were Klebsiella pneumoniae (20.5%) and Staphylococcus epidermidis (23.6%), respectively. The most significant risk factors for evisceration in both endogenous and exogenous groups were impaired initial VA and corneal ulcer. The proportion of patients with endogenous endophthalmitis who underwent evisceration (13.9%) was significantly higher than their exogenous counterparts (5.5%). Conclusions: Timely identification and proper management are essential for patients at risk of developing endophthalmitis in emergency settings. This is particularly important for individuals who exhibit compromised initial visual acuity and suffer from corneal ulcers. Despite intensive therapy, the long-term visual outcomes for endogenous endophthalmitis are generally worse compared to the exogenous form.