(BMJ)—A 52-yo woman w/ hx of diabetes presented w/ 4 days of progressive L eye pain and vision loss. She underwent L cataract removal ≈3mo prior and was receiving intravitreal injections for diabetic macular edema (last injection 4 days prior). She wore glasses but never contacts. The pt denied flashers or floaters in her vision and hadn’t experienced fevers, chills, headaches, jaw pain, trauma, or foreign body sensation. What’s the dx?
Corneal ulcer
Chalazion
Hypopyon
Hordeolum
Hyphema
You are correct. The photo demonstrates a hypopyon, or white blood cells layering in the anterior chamber. This is suggestive of endophthalmitis, a vision-threatening emergency that’s typically due to a bacterial infection from surgery, trauma, or extension of keratitis, and urgent consultation w/ an ophthalmologist is indicated. Intravitreal abx are the mainstay of tx, and systemic (PO or IV) abx may be indicated in severe cases. This pt was treated w/ intravitreal vancomycin and ceftazidime, prednisolone and atropine drops, and PO moxifloxacin.

Emergency Medicine Journal 2020;37:140-150