Endophthalmitis is always a race against time. Researchers conducted a study to see just how much each delayed day may count against visual outcomes and found significantly different outcomes based on the timing of care. 

The retrospective study included 130 patients with endophthalmitis who were seen at the Duke Eye Center between 2009 and 2018. Patients were grouped by those presenting to medical care early (within two days) or later (delayed, three days or more) from the time of symptom onset.

Patients who presented later had significantly worse visual acuity on initial exam (delayed 20/2941 vs. early 20/1124) and at six months follow up (delayed 20/547 vs. early 20/173). The researchers found that pre-endophthalmitis visual acuity was significantly correlated with visual acuity at six months, regardless of time to presentation.

Though rare, endophthalmitis sometimes occurs after intraocular surgery. Patients with glaucoma drainage device-related endophthalmitis were more likely to have a delayed presentation, and eyes with a delayed presentation were more likely to have conjunctival injection on initial exam (delayed 73% vs. early 52%). The researchers noted that pre-endophthalmitis visual acuity, pain and patient-reported blurred vision weren’t associated with early or delayed presentation.

As suspected, any delay in seeking medical care for endophthalmitis was associated with worse visual acuity on both the initial exam and at six months follow-up. The researchers note that further investigation may help to improve anticipatory guidelines for at-risk patients.

Mirzania D, Fleming TL, Robbins CB, et al. Time to presentation after symptom onset in endophthalmitis: Clinical features and visual outcomes. Ophthalmology Retina. August 1, 2020. [Epub ahead of print].