key: cord-0798351-4h4x7lmc
authors: Khatwani, Paras R; Goel, Nikita P; Trivedi, Kinjal Y; Aggarwal, Somesh V
title: Unveiling endophthalmitis post COVID-19 – A case series
date: 2021-09-25
journal: Indian J Ophthalmol
DOI: 10.4103/ijo.ijo_1616_21
sha: d4073def60e3935f2ef2f175ed5de051302f16a3
doc_id: 798351
cord_uid: 4h4x7lmc

Since December 2019, coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global pandemic. There has been a resurgence in complications involving various organs in patients recovered from COVID-19, and endophthalmitis is one of them. Endophthalmitis—an inflammation of intraocular tissues leading to loss of vision or even loss of eye—has been a rare occurrence in the past, but has been on the rise in the post-COVID-19 times. Here we report seven such cases.

25%-31% are post-traumatic, and only a small percentage are caused by either a hematogenous spread from a systemic infection (endogenous) or direct spread from a neighboring infective foci. [2, 3] Endophthalmitis, apart from being a blinding condition, can also lead to perforation, panophthalmitis, or spread to neighboring structures, and eventually loss of eye. Endogenous endophthalmitis and endophthalmitis with orbital cellulitis are both extremely uncommon entities and such cases are on the rise post the dreaded COVID-19 infection, and early detection and treatment is the key to preserve vision. Herein, we report seven such cases.

Demography, symptoms, clinical signs, diagnosis and the microbiological profile of the seven cases that we have seen are summarized in Table 1 .

Endophthalmitis, not associated with a history of surgery, trauma tends to have a poor prognosis due to difficulty in diagnosing and identifying the causative organisms. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Here, we have reported seven cases of endophthalmitis post-COVID-19 infection in a span of one month presenting at our tertiary care center. All patients were COVID-19 positive and received systemic steroids, oxygen therapy, anticoagulants, and anti-viral drugs as a standard treatment protocol. All patients upon being diagnosed with endophthalmitis underwent a Pars Plana Vitrectomy with intra-vitreal anti-fungal injection. They were also started on systemic antimicrobial agents based on the culture sensitivity report.

O f t h e s e ve n c a s e s , t h r e e we r e s e c o n d a r y t o mucormycosis-associated sinusitis and orbital cellulitis. One had endophthalmitis in one eye and panophthalmitis in the other with secondary orbital cellulitis caused by mucormycosis-associated bilateral pansinusitis. Two patients had endogenous endophthalmitis secondary to a systemic fungal infection, one of which was polymicrobial. One patient had endogenous endophthalmitis, leading to panophthalmitis with secondary orbital cellulitis.

Vitreous taps were not obtained from any patients as ocular fluid cultures are recommended only when organisms cannot be isolated from a nonocular source. [4] Ratra et al. [5] reported 85.3% bacterial and 14.7% fungal cause of culture-positive endogenous endophthalmitis. In our Table 1 

Case no. This shows an increasing trend of fungal endophthalmitis post COVID-19, which generally has a subacute course, leading to a delayed presentation and hence a poor prognosis.

As fungal infections are on the rise in patients recovered from COVID-19, a high index of suspicion is essential in patients having ocular complaints as early diagnosis and treatment is crucial in salvaging vision.

A thorough systemic evaluation is imperative to identify any systemic infective foci and prevent the spread of infection by its appropriate treatment.

The endophthalmitis vitrectomy study

Posttraumatic endophthalmitis

Perforating ocular injuries

Metastatic bacterial endophthalmitis: A contemporary reappraisal

Endogenous endophthalmitis: A 10-year retrospective study at a Tertiary Hospital in South India

We acknowledge Dr. Hansa H Thakkar, Director, M and J Western Regional Institute of Ophthalmology for her invaluable guidance and support throughout the preparation of this manuscript. We also thank the staff and patients of M and J Western Regional Institute of Ophthalmology for their cooperation.

Nil.

There are no conflicts of interest.