Endophthalmitis is a serious inflammation inside the eye, usually caused by bacteria or fungi. It is considered a medical emergency because, without quick treatment, it can cause rapid and permanent loss of vision. The condition most often develops after eye surgeries, especially cataract surgery, where it occurs in about 0.02% to 0.2% of cases worldwide. It can also happen after a penetrating eye injury, which increases the risk of infection because germs can enter directly into the eye.
A less common form, called endogenous endophthalmitis, occurs when an infection elsewhere in the body spreads to the eye through the bloodstream. This is more likely in people with conditions that weaken the immune system, such as diabetes, HIV, cancer, or in individuals who use intravenous drugs. Severe or untreated infections of the cornea (the clear front part of the eye), known as keratitis, can also lead to endophthalmitis if the cornea becomes damaged or perforated.
Bacteria such as Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus species, as well as fungi like Candida and Aspergillus, are common causes. Treatment usually involves injecting strong antibiotics or antifungal drugs, such as vancomycin, ceftazidime, amphotericin B, or voriconazole, directly into the eye. In severe cases, doctors may perform a vitrectomy, a surgical procedure that removes infected fluid and debris from inside the eye.
Symptoms often include intense eye pain, redness and swelling, sudden vision loss, sensitivity to light, and seeing floaters or flashes. The eye may also look white or cloudy because of pus inside the eye. Prevention focuses on careful cleaning of the eye before surgery, commonly using povidone-iodine, as well as giving preventive antibiotics when needed and treating eye injuries or infections promptly to reduce the risk of infection spreading to the eye.
Classification of Endophthalmitis
Endophthalmitis is classified into exogenous and endogenous types.
Exogenous endophthalmitis occurs when germs enter the eye from an outside source. This usually happens after eye surgery, most commonly cataract surgery, which is the world’s most frequently performed ophthalmic procedure. Even with modern sterile techniques, a small number of cases still occur when bacteria gain access to the interior of the eye during or shortly after surgery. Other causes include traumatic injuries, particularly those involving sharp objects or foreign bodies, which allow microorganisms to enter directly. Additionally, exogenous cases may occur after intravitreal injections, which are commonly used to treat retinal diseases such as macular degeneration or diabetic retinopathy. Although the risk per injection is extremely low, the high volume of injections worldwide has increased the overall number of reported cases. The organisms involved in exogenous infections are often bacteria from the skin or environment, which may cause rapid and severe inflammation.
Endogenous endophthalmitis, in contrast, happens when an infection elsewhere in the body travels to the eye through the bloodstream. This typically originates from distant sites such as the lungs, urinary tract, or heart valves. Because the eye is normally protected by the blood–ocular barrier, this form of endophthalmitis is less common. It is more frequently seen in individuals who are immunocompromised, meaning their immune system is weakened and cannot control infections effectively. Conditions that increase susceptibility include diabetes, cancer, HIV infection, long-term steroid use, organ transplantation, and intravenous drug use. The organisms involved in endogenous endophthalmitis can be either bacteria or fungi, and fungal cases, particularly those caused by Candida species, are relatively more common in this category.
Epidemiology
The rate at which endophthalmitis occurs varies depending on the underlying cause. Postoperative endophthalmitis, which follows eye surgery, remains the most frequent type. After cataract surgery, studies worldwide estimate the incidence to range from 0.05% to 0.3%, reflecting improvements in surgical techniques and infection-control practices. Factors that increase postoperative risk include prolonged surgery, wound leakage, contaminated surgical instruments, and inadequate antiseptic preparation, such as insufficient use of povidone-iodine.
Traumatic endophthalmitis is less common but often more severe. It occurs when penetrating injuries introduce aggressive bacteria or foreign material into the eye. Such cases are associated with worse visual outcomes because trauma can damage multiple eye structures before infection even begins. Although exact global statistics vary, traumatic cases generally account for a smaller proportion of total endophthalmitis episodes but have a disproportionately high rate of complications, including loss of vision or even loss of the eye.
Endogenous endophthalmitis represents approximately 2% to 8% of all reported cases. It is more frequent in populations with high rates of systemic infections or immune-weakening conditions. In some regions, particularly in parts of Asia, the proportion of endogenous cases is higher due to increased rates of liver abscesses and bloodstream infections caused by organisms like Klebsiella pneumoniae. Hospitalized patients, especially those in intensive care units, also face increased risk due to invasive procedures, intravenous catheters, and broad-spectrum antibiotic use that can alter normal microbial balance.
Etiology and Risk Factors
Endophthalmitis arises from various sources of infection and is influenced by specific clinical conditions. These origins are broadly classified by the route of infection and factors that increase susceptibility.
Exogenous Causes
Exogenous endophthalmitis occurs when infectious agents enter the eye from an external source. This is the most common route of infection. The leading cause is postoperative infection following eye surgery, particularly cataract extraction, the most frequently performed eye surgery globally. Although modern surgical techniques and sterilization methods have significantly reduced risk, microorganisms can still enter the eye through small surgical incisions or due to wound leaks. Another major contributor is intravitreal injections, widely used in treating retinal conditions such as diabetic retinopathy or macular degeneration. Even though each individual injection carries a very low risk, the large number performed worldwide has increased the overall incidence of injection-related infections.
Trauma is another important exogenous cause. Penetrating eye injuries, such as those caused by sharp objects, industrial accidents, or explosive fragments, can directly introduce bacteria or fungi deep into the eye. Injuries involving organic material, like wood splinters, plant matter, or soil, are more likely to involve fungal pathogens, particularly Candida and other environmental fungi. In some situations, infections arise due to contaminated surgical instruments, improperly sterilized equipment, or contaminated topical medications. Although rare, these sources can lead to outbreaks and are considered serious failures of infection control.
The organisms responsible for exogenous cases are often bacteria normally found on the skin or in the environment. The most frequent include Staphylococcus aureus, Staphylococcus epidermidis, and various Gram-negative bacilli such as Pseudomonas aeruginosa. More virulent pathogens such as Bacillus cereus can be involved in trauma-related cases and are known for causing extremely rapid and destructive infections.
Endogenous Causes
Endogenous endophthalmitis results from infectious organisms traveling to the eye through the bloodstream, a process known as hematogenous spread. This occurs when microorganisms enter the circulation from another part of the body and cross the blood–ocular barrier, a protective structure that normally prevents pathogens from accessing internal eye tissues. This form of the disease is far less common than exogenous endophthalmitis but can be more difficult to diagnose because it occurs without any direct injury to the eye.
Common sources of disseminated infection include bacterial endocarditis (infection of the heart valves), pneumonia, urinary tract infections, liver abscesses, and infections resulting from intravenous drug use. Individuals with weakened immune systems, such as those with diabetes, HIV infection, cancer, or on long-term immunosuppressive therapy, are at particularly high risk. In these patients, even minor systemic infections can spread and seed the eye.
Endogenous infections are often caused by bacteria such as Staphylococcus aureus and Streptococcus species. Fungal infections, particularly those caused by Candida, are also common, especially in hospitalized patients receiving intravenous nutrition, broad-spectrum antibiotics, or having long-standing intravenous catheters. In certain regions, notably parts of Asia, Klebsiella pneumoniae from liver abscesses has emerged as a leading cause of endogenous disease.
Precipitating Factors
A variety of environmental, medical, and patient-related factors can significantly increase the risk of developing endophthalmitis. Prior ocular surgery, especially cataract extraction, is the most common trigger for exogenous infection. Procedures involving direct entry into the eye, such as vitrectomy or intravitreal injections, also increase susceptibility. Penetrating ocular trauma presents one of the highest risks, particularly when the injury involves soil, metal fragments, or foreign bodies that remain in the eye.
Systemic conditions play a major role in endogenous cases. Diabetes mellitus impairs immune function and delays healing, making the eye more vulnerable to infection. Immunosuppressed individuals, including transplant recipients and patients on chemotherapy, are at heightened risk due to their reduced ability to contain bloodstream infections. Intravenous drug use is another major factor, as contaminated needles can introduce bacteria and fungi directly into the bloodstream.
Other contributors include poor wound care after eye surgery, the use of contaminated eye drops, or failure to follow postoperative hygiene instructions. Preventive measures such as strict sterilization protocols, the routine use of povidone-iodine for preoperative antisepsis, and appropriate prophylactic antibiotics have been shown to significantly reduce risk. Ensuring proper wound closure and monitoring patients with systemic infections also plays a crucial role in prevention.
| Risk Factor | Association | Common Pathogens |
| Cataract surgery | Exogenous endophthalmitis | Staphylococcus epidermidis |
| Ocular trauma | Exogenous endophthalmitis | Bacillus cereus |
| Systemic infection | Endogenous endophthalmitis | Candida, Staphylococcus |
| Immunosuppression | Endogenous risk | Fungal and bacterial |
Pathogenesis
Endophthalmitis develops through the entry and multiplication of microorganisms within the eye, followed by inflammatory reactions from the host. The process depends on the type of infecting organisms and the immune status of the patient.
Microbial Invasion
Microbial invasion begins when bacteria, fungi, or, less commonly, viruses breach the natural protective barriers of the eye. Under normal circumstances, structures such as the cornea, sclera, and blood–ocular barrier prevent pathogens from entering. Entry usually occurs in one of three ways:
- External entry, such as after eye surgery or penetrating trauma;
- Direct inoculation during medical procedures, such as intravitreal injections; or
- Internal spread, when microorganisms travel from a distant body site through the bloodstream, a process known as hematogenous dissemination.
Different microorganisms tend to dominate depending on the route of infection. Staphylococcus epidermidis, a common skin bacterium, is the leading cause of postoperative infections due to its ability to adhere to surgical wounds and form biofilms, protective layers that make bacteria harder to eliminate. Staphylococcus aureus, a more aggressive species, can enter through wounds or systemic infections and often causes faster, more destructive disease. Gram-negative bacteria, such as Pseudomonas aeruginosa or Klebsiella pneumoniae, may lead to severe infections due to their rapid growth and toxin production. In endogenous cases, fungal organisms, especially Candida species, are common, particularly in patients with bloodstream infections, intravenous catheters, or weakened immune systems.
Once inside the eye, microorganisms multiply within the vitreous humor (a gel-like structure filling the back of the eye) and the aqueous humor (the fluid in the front chamber). The vitreous lacks blood vessels (avascular), which means the immune system has limited ability to detect and neutralize invading pathogens. This allows many microorganisms to grow rapidly and produce toxins or enzymes that directly damage retinal tissue.
Host Immune Response
The immune response plays a central role in the progression and severity of endophthalmitis. Although the eye is considered an immune-privileged site, a location where excessive inflammation is normally suppressed to preserve vision, this protective state collapses during infection.
The first line of defense is the innate immune system. Immune cells such as neutrophils arrive quickly by crossing the blood–ocular barrier. These cells release enzymes and reactive oxygen species, which are chemical substances designed to kill pathogens. However, these same substances can inadvertently injure surrounding retinal cells, contributing to scarring and vision loss. At the same time, inflammatory signaling molecules known as cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), increase dramatically. These cytokines amplify the inflammatory response by recruiting more immune cells and increasing vascular permeability.
The adaptive immune system becomes active in the later stages. T cells recognize pathogen-specific antigens and coordinate additional immune responses, while B cells may produce antibodies to help neutralize the organisms. Although adaptive immunity helps contain long-standing or severe infections, it may also intensify inflammation, further contributing to tissue damage. The outcome of endophthalmitis depends on the delicate balance between controlling the infection and limiting immune-mediated injury. Excessive inflammation, even when directed at pathogens, can destroy sensitive retinal structures and result in permanent vision loss.
Clinical Presentation
Endophthalmitis presents with a rapid onset of symptoms that typically affect vision and cause ocular discomfort. Physical signs often indicate severe intraocular inflammation, and different variants may show distinctive patterns depending on the cause and timing.
Symptoms
Patients usually report sudden and significant decrease in visual acuity, ranging from blurred vision to near complete loss. Severe eye pain is common and often progresses quickly.
Other frequent symptoms include redness, photophobia, and floaters. Some patients experience eyelid swelling and discharge, especially in infectious cases. Systemic symptoms like fever may be present if the infection is endogenous.
Physical Examination Findings
Examination reveals marked conjunctival hyperemia and corneal edema. The anterior chamber often shows hypopyon, which is pus or inflammatory cells layering in the chamber.
There is typically a significant vitritis, seen as haze in the vitreous body. Intraocular pressure may be elevated or decreased, depending on the stage and type of endophthalmitis.
Fundoscopic view can be obscured by media opacities. Pain on eye movement and restricted ocular motility may be present with posterior inflammation.
Variants of Clinical Manifestation
Exogenous endophthalmitis occurs after external injury or surgery, with severe pain and rapid symptom onset within days. It often presents with a hypopyon and marked cellular reaction in both the anterior and posterior segments.
Endogenous endophthalmitis arises from systemic infection and is more insidious. It may have milder anterior symptoms initially, with posterior segment inflammation predominating.
Chronic endophthalmitis presents weeks to months post-surgery with low-grade inflammation, less pain, and intermittent symptoms, making diagnosis more difficult.
Diagnostic Methods
Accurate diagnosis of endophthalmitis relies on a combination of clinical signs, laboratory tests, and imaging studies. Each method provides critical information to identify the infection and guide appropriate treatment.
Clinical Evaluation
Clinical evaluation is the first and most critical step in diagnosing endophthalmitis. A detailed history provides essential clues about the likely source and causative organisms. Recent ocular procedures, especially cataract surgery, intravitreal injections, or glaucoma surgeries, significantly raise suspicion for postoperative endophthalmitis. In cases involving ocular trauma, clinicians assess the mechanism of injury, presence of intraocular foreign bodies, and time elapsed since injury. Inquiry about systemic conditions, including diabetes, immunosuppression, intravenous drug use, or active infections, helps identify potential endogenous cases.
During examination, clinicians assess hallmark symptoms such as ocular pain, sudden or progressive decrease in vision, eyelid swelling, photophobia, and profuse tearing. Symptom severity often correlates with the virulence of the infecting organism; for instance, gram-negative infections may progress dramatically within hours, while Staphylococcus epidermidis infections often present more subtly.
A thorough slit-lamp biomicroscopy examination allows evaluation of the anterior segment. Common findings include marked conjunctival injection, corneal edema, fibrin accumulation, and a hypopyon, which is the layering of inflammatory cells in the anterior chamber. A hypopyon strongly suggests infection but may occasionally occur in sterile inflammation; therefore, context is important. The degree of vitreous haze, often assessed with indirect ophthalmoscopy, indicates posterior segment involvement. In severe cases, visualization of the fundus is impossible due to dense inflammatory debris.
Assessment of visual acuity is essential not only for diagnosis but also for prognosis and treatment decisions. Patients presenting with hand-motion or light-perception vision generally have more severe disease and may require urgent vitrectomy.
Microbiological Testing
Microbiological investigation forms the cornerstone of confirming the causative organism. Obtaining ocular samples should occur promptly and under sterile conditions. Vitreous samples are generally more reliable than aqueous samples because the infectious load is typically higher in the vitreous cavity. Collection methods include vitreous tap with a needle or a core vitrectomy using a vitrectomy cutter. When a diagnostic vitrectomy is performed, larger sample volumes improve diagnostic yield.
Once collected, samples undergo Gram staining, which provides rapid preliminary information on the presence and morphology of bacteria. This immediate insight helps guide empiric therapy. Cultures are then performed using appropriate media for bacteria and fungi; aerobic, anaerobic, and fungal cultures may be necessary, especially in high-risk patients such as those with trauma or immunosuppression.
Despite careful sampling, culture positivity rates can vary, often around 40–70%, due to prior antibiotic exposure or fastidious organisms. To overcome these limitations, molecular techniques such as polymerase chain reaction (PCR) have become invaluable. PCR can detect bacterial and fungal DNA even when cultures are negative or when organisms are slow-growing, such as Propionibacterium acnes (now Cutibacterium acnes) or certain fungi. Real-time PCR assays can provide results within hours, significantly expediting targeted therapy.
Once a pathogen is identified, antimicrobial susceptibility testing determines appropriate drug choices.
Imaging Techniques
Imaging plays a vital role in diagnosing endophthalmitis, especially when clinical visualization is limited due to corneal edema or dense vitritis. B-scan ultrasonography is the primary imaging modality used in these cases. It allows clinicians to evaluate the posterior segment when direct ophthalmoscopy is not possible. Ultrasonography can detect vitreous opacities, loculated abscesses, membranes, choroidal detachment, and retinal detachment, all of which influence management decisions. It is especially useful in differentiating between severe vitritis and other pathologies such as suprachoroidal hemorrhage.
Optical coherence tomography (OCT) provides high-resolution cross-sectional imaging of the retina and is particularly useful once media clarity improves. OCT can detect structural complications such as cystoid macular edema, subretinal fluid, and disruptions of the retinal layers. Although less frequently used in the acute phase due to poor visualization, OCT becomes invaluable during recovery or follow-up to monitor macular integrity and guide prognosis.
In selected complex cases, additional imaging such as computed tomography (CT) or MRI may be recommended, particularly if an intraocular foreign body is suspected or if clinicians need to assess extraocular extension in suspected panophthalmitis. However, these modalities are not routine for standard cases.
Management Strategies
The management of endophthalmitis focuses on two major goals: rapid elimination of the infecting organism and preservation of visual function. Because the condition progresses quickly and can cause permanent damage within hours.
Antimicrobial Therapy
Intravitreal antimicrobial therapy, injecting antibiotics or antifungal agents directly into the eye, is the cornerstone of treatment for almost all forms of endophthalmitis. Delivering medication into the vitreous cavity allows high concentrations of drugs to reach the site of infection, bypassing the natural barriers that normally limit the entry of medications delivered orally or intravenously.
A commonly used combination includes vancomycin to treat Gram-positive bacteria such as Staphylococcus aureus and Staphylococcus epidermidis, and ceftazidime or amikacin to provide broad coverage against Gram-negative organisms. For suspected fungal endophthalmitis, agents such as amphotericin B or voriconazole may be used. The selection of drugs is based not only on likely pathogens but also on local antibiotic resistance patterns, which vary by hospital and region.
Although systemic antibiotics (taken orally or intravenously) may be used alongside intravitreal therapy, they are generally not effective as a standalone treatment because only small amounts penetrate into the eye. They are most useful in endogenous cases, where the source of infection is elsewhere in the body, such as the bloodstream or an infected organ.
Topical antibiotics, delivered as eye drops, may help reduce surface bacteria and support treatment, but they do not achieve therapeutic levels inside the eye. Therefore, they cannot replace intravitreal injections. In addition to antibiotics, patients may receive topical corticosteroids to help control inflammation, although these must be used cautiously to avoid worsening certain infections.
A crucial step in management is obtaining diagnostic samples, such as vitreous or aqueous fluid, before antibiotics are given. These samples are used for laboratory culture or molecular testing to identify the specific pathogen. However, treatment is never delayed while waiting for results, as studies show that even short treatment delays reduce the likelihood of preserving vision.
Surgical Intervention
Pars plana vitrectomy (PPV) is an important surgical treatment option for endophthalmitis, especially in severe or rapidly progressing cases. A vitrectomy involves removing the infected vitreous gel from inside the eye and replacing it with a sterile solution. This procedure achieves several important goals:
- Removes infectious organisms, toxins, and inflammatory debris.
- Improves visualization of the retina, allowing the surgeon to assess damage or repair retinal tears.
- Enhances the penetration and distribution of intravitreal antibiotics.
- Reduces the load of inflammatory mediators, which can damage delicate structures like the retina and optic nerve.
Early vitrectomy is particularly beneficial for patients who present with very poor vision, such as only being able to detect light, or in cases caused by highly virulent organisms like Bacillus cereus or certain Gram-negative bacteria, which can cause rapid destruction of ocular tissues. In these situations, surgery may offer a better chance of preserving remaining vision compared with medical therapy alone.
The decision to perform surgery depends on several factors, including the speed of symptom onset, the severity of inflammation, the patient’s initial visual acuity, and the presence of complications such as retinal detachment. Close collaboration between vitreoretinal surgeons and infectious disease specialists is essential to tailor both surgical and antimicrobial therapy to the individual patient.
After surgery, patients continue receiving intravitreal or systemic antimicrobial therapy. They require intensive postoperative monitoring to identify complications early. Potential complications include recurrent infection, elevated intraocular pressure, retinal detachment, or the need for additional surgeries.
Outcomes and Prognosis
The prognosis of endophthalmitis depends largely on the timeliness and appropriateness of treatment. Visual outcomes vary considerably with underlying causes, patient health, and the nature of the infecting organism.
Prognostic Factors
Several factors influence the prognosis of endophthalmitis. The initial visual acuity at presentation is a strong predictor; worse vision correlates with poorer outcomes. The causative microorganism also plays a critical role—virulent bacteria like Pseudomonas species often lead to worse results than less aggressive pathogens.
Time to treatment initiation is essential. Delayed therapy increases the risk of permanent vision loss. Patient-related factors such as immune status and coexisting ocular conditions, like diabetes or glaucoma, can also adversely affect recovery.
Visual Recovery
Visual recovery after endophthalmitis varies widely. In cases caused by less aggressive organisms and treated promptly, patients may regain near-normal vision. However, many experience residual deficits, ranging from mild visual impairment to complete blindness.
The degree of intraocular inflammation and damage to ocular structures like the retina or optic nerve determines the extent of visual recovery. Surgical interventions combined with antibiotics improve chances but do not guarantee full restoration.
Complications
Complications of endophthalmitis can be profound, often determining whether useful vision can be preserved. Because the eye is a highly specialized and enclosed organ, any prolonged infectious or inflammatory process can disrupt its delicate architecture. One of the major complications is retinal detachment, which may occur due to the inflammatory breakdown of retinal structures, vitreoretinal traction, or intraocular abscess formation. Retinal detachment greatly worsens prognosis and often necessitates additional surgical intervention.
Another common complication is cataract formation, particularly following severe inflammation or repeated intraocular procedures. Inflammatory mediators accelerate lens opacification, and in cases of fungal or chronic bacterial infections, the process may progress rapidly. Additionally, macular edema and epiretinal membrane formation may develop as the retina responds to prolonged inflammation, contributing to persistent visual impairment even after the infection resolves.
Endophthalmitis can also lead to secondary glaucoma, primarily due to infiltration and obstruction of the trabecular meshwork by inflammatory cells, fibrin, or debris. Elevated intraocular pressure (IOP) becomes dangerous if left untreated, as it can further damage the optic nerve. Persistent or uncontrolled inflammation may cause optic nerve atrophy, resulting in irreversible vision loss.
In the most severe cases, especially when the infection is caused by highly virulent organisms like Pseudomonas aeruginosa or Bacillus cereus, the inflammation can rapidly destroy intraocular tissues, leading to panophthalmitis, where the infection extends to the sclera and surrounding orbital tissues. If damage progresses despite aggressive treatment, the eye may progress to phthisis bulbi, a shrunken, non-functional globe characterized by scarring, atrophy, and loss of intraocular structure.
Prevention
Surgical Prophylaxis
Preventing endophthalmitis begins with meticulous pre-, intra-, and postoperative precautions. One of the most effective preventive strategies is the intracameral administration of antibiotics at the close of cataract surgery. Agents such as cefuroxime, moxifloxacin, or vancomycin (where appropriate and safe) have been shown to significantly reduce postoperative infections. Large-scale studies, including the European Society of Cataract and Refractive Surgeons (ESCRS) trial, demonstrated a substantial reduction in infection rates following intracameral prophylaxis, leading to its adoption worldwide as a standard preventive measure.
Preoperative antisepsis remains equally crucial. Application of povidone-iodine 5–10% to the conjunctival sac and periocular skin is widely regarded as the single most effective measure against postoperative ocular infections. Povidone-iodine rapidly reduces bacterial load, including common pathogens such as Staphylococcus epidermidis and Staphylococcus aureus, and maintains activity in the presence of organic materials. Ensuring the correct exposure time, typically at least three minutes, is essential for optimal antimicrobial effect.
During surgery, maintaining a completely sterile environment is mandatory. This includes proper preparation of the surgical field, use of sterile drapes and instruments, and strict adherence to aseptic technique. Surgeons must avoid unnecessary manipulation of ocular tissues and minimize surgery duration, as prolonged operative time increases the risk of microbial contamination. Intraoperative complications such as posterior capsule rupture significantly heighten infection risk, making careful surgical technique a key factor in prevention.
Infection Control Practices
Prevention of endophthalmitis also extends beyond the operating room, relying on robust infection-control measures at the facility level. Surgical instruments must undergo validated sterilization processes, typically steam autoclaving, to ensure complete eradication of potentially harmful microorganisms. Increasing use of disposable surgical instruments in ophthalmic procedures also helps reduce cross-contamination risk, particularly in high-volume centers.
Strict hand hygiene protocols for all surgical and support staff are critical. Guidelines recommend handwashing with antimicrobial soap or alcohol-based hand rubs before gowning and gloving. The use of sterile gloves, gowns, masks, and drapes minimizes the potential for microbial introduction during surgery, while compliance with mask protocols prevents contamination through respiratory droplets.
Environmental cleanliness is another vital component. High-touch surfaces, surgical tables, phacoemulsification units, and microscope parts must be thoroughly disinfected between procedures. Facilities should implement routine environmental surveillance, monitoring for microbial contamination and ensuring adherence to cleaning standards.
Hospitals and surgical centers benefit from infection surveillance systems that track endophthalmitis rates over time. These systems help identify clusters, procedural lapses, or contaminated equipment early, allowing rapid corrective actions.