7.4 Endophthalmitis, Post-Operative, (Exogenous Endophthalmitis)

eyes.nhs.scot/
Eyecare Guidelines/
Section 7 - Uvea/
7.4 Endophthalmitis, Post-Operative, (Exogenous Endophthalmitis)

Date of last review:

29/4/2026

Date of next review:

29/4/2028

Date of publication:

6/7//2026

Differential Diagnosis ⁽¹⁾

Endogenous endophthalmitis (due to haematological spread of various pathogens)
Postoperative sterile inflammation, e.g. from retained lens material
Toxic Anterior Segment Syndrome (TASS)
Other causes of acute red eye, for example acute anterior uveitis
Vitreous haemorrhage

Possible management by optometrist

Advice

No non-pharmacological treatment is recommended ⁽¹⁾
Following ophthalmic examination;
- Clearly communicate the urgency of the condition ⁽⁷⁾ 
- Instruct the patient they are required to attend the hospital eye department (or A&E if no ophthalmology support available) immediately ⁽⁷⁾

Treatment

No optometric treatment— emergency referral required ⁽¹⁾
- Follow local protocols for same-day referral ⁽⁷⁾

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

Not applicable for this condition (7)

Further management options

Emergency referral with no optometric intervention ⁽¹⁾
- Explain to the patient that they must be seen urgently
- Follow local protocols for same-day referral ⁽⁷⁾
- Ensure a clinician (in the receiving department) is informed the patient is attending ⁽¹⁾

Possible management in secondary care or local/community pathways where available

See Further management options ^(1,7)
Treatment initiated within one hour of diagnosis ⁽¹⁾
Hospital admission ⁽¹⁾
Ultrasound to assess vitreous involvement (if media is hazy) ⁽¹⁾
Anterior chamber/vitreous tap or vitrectomy, with microbiological testing ⁽¹⁾
Broad spectrum intravitreal antibiotics, e.g.⁽¹⁾:
- Ceftazidime
- Vancomycin
Adjunctive therapy ⁽¹⁾:
- Intravitreal corticosteroids
- Oral antibiotics (case dependent)
Pars plana vitrectomy for severe or rapidly progressing cases ⁽¹⁾

College of Optometrists Clinical Management Guideline⁽¹⁾ 

Endophthalmitis (post-operative) (exogenous endophthalmitis) - College of Optometrists *

* With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

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The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

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Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

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