Endophthalmitis in eyes presenting with orbital signs: a case-control study.

Purpose: The purpose of this study was to assess the clinical profile and treatment outcomes in eyes with endophthalmitis presenting with orbital signs.

Methods: A case-control study of 24 eyes with endophthalmitis and orbital signs at presentation (defined as ocular motility restriction and/or presence of " inverted perpendicular" sign on ultrasonography) was conducted between January 2000 and December 2006. The control group was constituted of 40 age- and sex-matched eyes with endophthalmitis presenting without orbital signs. Optimal structural outcome was defined as resolution of inflammation and infection. Adverse structural outcome was defined as development of phthisis bulbi or need for evisceration or development of retinal detachment. Optimal functional outcome was defined as improvement in postoperative visual acuity to 3/60 or better. The Pearson chi-square test was used with appropriate significance (P < or = 0.05) to compare the mean visual acuity before and after treatment.

Results: Twenty-four patients with a mean age of 46.4 years and a mean follow-up of 14.6 months were included. Treatment options included intravitreal antibiotics, vitrectomy, evisceration, and systemic antibiotics. Optimal structural outcome was achieved in 6 (25%) eyes. A total of 70.8% eyes had no light perception, whereas 4 (16.66%) patients regained ambulatory vision (>3/60). There was a statistically significant poor visual (P = 0.05) and structural outcome (P = 0.004), whereas in the control group, 25 patients (62.5%) had vision 3/60 or better (P = 0.001).

Conclusion: Orbital signs are independent risk factors for poor structural and visual outcomes in eyes with endophthalmitis.