A 60-year-old woman comes to the emergency department due to decreasing vision and a dull ache over her left eye for the past 12 hours. She had a successful surgical cataract extraction in her left eye 5 days ago. Temperature is 38.1 C (100.6 F), blood pressure is 140/90 mm Hg, pulse is 92/min, and respirations are 14/min. Examination of the left eye reveals a swollen eyelid, edematous conjunctiva, and exudates in the anterior chamber. Testing with Snellen's chart demonstrates decreased visual acuity in her left eye. What is the most likely diagnosis?

Question

A 60-year-old woman comes to the emergency department due to decreasing vision and a dull ache over her left eye for the past 12 hours.  She had a successful surgical cataract extraction in her left eye 5 days ago.  Temperature is 38.1 C (100.6 F), blood pressure is 140/90 mm Hg, pulse is 92/min, and respirations are 14/min.  Examination of the left eye reveals a swollen eyelid, edematous conjunctiva, and exudates in the anterior chamber.  Testing with Snellen's chart demonstrates decreased visual acuity in her left eye.  What is the most likely diagnosis?

Quizplus · Accepted Answer

Postoperative endophthalmitis is the most common form of endophthalmitis. It usually occurs within 6 weeks of surgery. Endophthalmitis refers to a bacterial or fungal infection within the eye, particularly the vitreous. Patients usually present with pain and decreased visual acuity. Examination reveals swollen eyelids and conjunctiva, hypopyon, corneal edema and infection. The vitreous can be sent for Gram stain and culture. Based on the severity, intravitreal antibiotic injection or vitrectomy is done. (Choice A) Conjunctivitis presents with excessive tearing, burning sensation, mild pain, conjunctival, and eyelid edema. Vision is not affected. (Choice B) Corneal ulceration presents as a foreign body sensation, blurred vision, photophobia, and pain. A history of contact lens use, recent trauma, or ocular disease may be present. The eye is erythematous, and ciliary injection is present. Purulent exudates are seen in the conjunctival sac and on the ulcer surface. (Choice C) Uveitis (ie, viral or parasitic infection within the eye) presents as blurred vision with moderate pain, conjunctival injection, and constricted pupils. Hypopyon (cell layering within the anterior chamber) is seen in severe anterior uveitis. Keratic precipitates ("mutton fat") and iris nodules may be seen. It is associated with HLA B27-related conditions. (Choice E) Cavernous sinus thrombosis is characterized by proptosis, ophthalmoplegia, chemosis, and visual loss. It occurs due to hematogenous spread from an infected, inflamed sinus. Educational objective: Postoperative endophthalmitis is the most common form of endophthalmitis. It usually occurs within 6 weeks of surgery. Patients usually present with pain and decreased visual acuity. Examination reveals swollen eyelids and conjunctiva, hypopyon, corneal edema and infection.

A 60-Year-Old Woman Comes to the Emergency Department Due to Decreasing