Bleb-related endophthalmitis

Guideline for ophthalmology use only. 

Refer all suspected cases of bleb-related endophthalmitis to ophthalmology. 

For other forms of endophthalmitis, including fungal and viral, see Endophthalmitis

PROCEDURE

Admit patient. 

1. Conjunctival swab, AC tap and vitreous tap or vitreous biopsy. 
2. Instil povidone iodine 5% into the conjunctival sac. 
3. Vitrectomy if severe or significant vitritis present. 
4. Administer intravitreal antibiotics: Intravitreal vancomycin 2mg in 0.1ml AND Intravitreal ceftazidime 2mg in 0.1ml 
5. In selected cases, administer intravitreal steroids: Dexamethasone 0.4mg (dexamethasone phosphate and preservative free brand Hospira). 
6. Topical and systemic antibiotics to be prescribed as for Blebitis, Acute
7. Topical steroids to be prescribed: Prednisolone eye drops (1%) qds to be administered after vitreous tap/biopsy. 
8. Systemic steroids to be commenced 12 hours after admission: Prednisolone 1mg/kg po od (max 60mg/day)