Chronic Endophthalmitis Masquerading as Uveitis

Chronic endophthalmitis is defined as a bacterial or fungal intraocular infection that has an indolent course over weeks to months before a correct diagnosis is made. Many cases have a delayed onset of symptoms following an inciting event such as ocular surgery or penetrating trauma. In some cases, the onset of symptoms occurs within the first month postoperatively (or post-trauma), yet the inflammation is low grade, persistent, or recurrent and mistaken for sterile uveitis, so the correct diagnosis is delayed for weeks to months. The most common pathogens are bacterial, such as Propionibacterium acnes and coagulase-negative staphylococci, though fungi can also be found in some cases. Signs and symptoms of chronic endophthalmitis may be mild and progress slowly. This requires clinicians to have a high level of suspicion and investigate such patients with a suggestive history. The diagnosis may be delayed, and many patients may receive courses of treatment with corticosteroids for presumed intraocular inflammation. Diagnosis is typically based on cultures and polymerase chain reaction (PCR) testing of intraocular samples, though treatment often is started before a definitive diagnosis is reached and in most cases requires a combination of intraocular antibiotics and surgery. Visual outcome depends on the pathogen, the presenting visual acuity, and the promptness of treatment. In chronic P. acnes endophthalmitis, at least 50 % of patients can achieve 20/40 vision or better with appropriate and timely treatment.