Time to Presentation after Symptom Onset in Endophthalmitis: Clinical Features and Visual Outcomes.

Journal Article (Journal Article)

PURPOSE: To investigate the impact of time from symptom onset to presentation on the clinical course and outcomes of eyes with endophthalmitis. DESIGN: Retrospective, longitudinal cohort study. PARTICIPANTS: One hundred thirty-three eyes of 130 patients with endophthalmitis. METHODS: Adults diagnosed with endophthalmitis at the Duke Eye Center from January 1, 2009, through January 1, 2018, were identified using the Duke Enterprise Data Unified Content Explorer. Patient demographics, time of symptom onset, presenting clinical features, management, and outcomes were recorded by retrospective review. Patients were divided into those seeking medical care either early (within 2 days) or later (delayed, i.e., 3 days or longer) with regard to symptom onset. Clinical features, management, and visual outcomes of eyes with early or delayed presentation were compared. MAIN OUTCOME MEASURES: Mean corrected visual acuity (VA) at presentation and at 6 months. RESULTS: In eyes with delayed presentation, VA was significantly worse on initial examination (delayed, 20/2941 vs. early, 20/1124; P = 0.009) and at 6 months (delayed, 20/547 vs. early, 20/173; P = 0.01). When controlling for time to presentation, VA before endophthalmitis was correlated significantly with VA at 6 months (Pearson r = 0.55; R2 = 29%; P < 0.0001). Eyes with glaucoma drainage device-related endophthalmitis were more likely to have a delayed presentation (P = 0.03). Eyes with delayed presentation were more likely to have conjunctival injection on initial examination (delayed, 73% vs. early, 52%; P = 0.01). Visual acuity before endophthalmitis, pain, and patient-reported blurred vision were not associated with early or delayed presentation (P > 0.05). CONCLUSIONS: Delayed presentation was associated with worse VA on initial examination and at 6 months in eyes with endophthalmitis. Presence of pain did not prompt earlier presentation. Visual acuity before endophthalmitis was associated with VA at 6 months, regardless of time to presentation. Further investigation may help to improve anticipatory guidelines for at-risk patients.

Full Text

Duke Authors

Cited Authors

  • Mirzania, D; Fleming, TL; Robbins, CB; Feng, HL; Fekrat, S

Published Date

  • April 2021

Published In

Volume / Issue

  • 5 / 4

Start / End Page

  • 324 - 329

PubMed ID

  • 32750428

Electronic International Standard Serial Number (EISSN)

  • 2468-6530

Digital Object Identifier (DOI)

  • 10.1016/j.oret.2020.07.027


  • eng

Conference Location

  • United States