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Archive November 2019 XX, No. 11

Pointers to Prevent Endophthalmitis

These tried-and-true techniques reduce the risk of infection following ophthalmology's most commonly performed procedures.

Christina Weng

Christina Weng, MD, MBA


Christina Y. Weng, MD, MBA
SURE SHOT Christina Weng, MD, MBA, applies 5% povidone-iodine on the ocular surface prior to administering an intravitreal injection.

Endophthalmitis, an infection involving the entire eye, is a rare complication of invasive procedures such as cataract surgery and intravitreal injections. Post-cataract surgery endophthalmitis rates vary, depending on the source, but are estimated to approximate 0.1%. However, because more than 3.5 million cataract surgeries are performed annually in the United States, a sizeable number of patients are at risk. The same holds true for intravitreal injections, of which over 7 million are performed in the United States each year for conditions such as wet macular degeneration, diabetic macular edema and diabetic retinopathy. Although the risk of post-injection endophthalmitis is low — estimated to be between 1 in 2,000 and 1 in 5,000 — a significant number of patients have the potential to be affected.

Post-cataract surgery or post-injection endophthalmitis can happen no matter how careful physicians are during procedures, but there are ways to minimize the risks.

  • Pre-operatively. Meibomian gland dysfunction or blepharitis should be optimized before surgery with lid hygiene management. Avoid concurrent nasolacrimal duct surgeries at the time of cataract surgery, as these procedures have been found to increase the risk of post-operative endophthalmitis.
  • Prepping. Staphylococcus species bacteria are responsible for more than half of post-cataract endophthalmitis cases. Most of the bacteria live on eyelashes, eyelid margins and periorbital skin, stressing the importance of proper pre-operative prepping.

Generously apply 10% povidone-iodine to the periorbital area. I also like to "paint" individual eyelashes as if applying mascara. It's important to clean the lid margins well, especially if the patient has severe blepharitis. But take care not to scrub too vigorously, which could cause microscopic wounds to form. Use 5% povidone-iodine to irrigate the ocular surface.

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