Endophthalmitis after pediatric strabismus surgery

Objective To report 6 cases of endophthalmitis after pediatric strabismus s urgery. Methods: Retrospective review of initial signs, clinical findings, treatmen t, culture results, and visual and anatomical outcomes in 6 eyes of 6 child ren treated at 2 tertiary care institutions between 1983 and 1998. Results: Four boys and 2 girls aged 8 months to 6 years (median age, 2 year s) developed lethargy and asymmetric eye redness, with or without eyelid sw elling or fever, within 4 days of surgery. At diagnosis (median, postoperat ive day 6) clinical findings included periorbital swelling, redness and leu kocoria due to vitritis, and, in some cases, hypopyon. Treatment included p ars plana vitrectomy and intravitreal and systemic antibiotics in all cases . Vitreous cultures grew Streptococcus pneumoniae, Haemophilus influenzae. and Staphylococcus aureus. Within 6 months of strabismus surgery, visual ac uity was no light perception in all eyes and 3 eyes had been enucleated. Th e 3 remaining eyes were prephthisical. Conclusions: Endophthalmitis after pediatric strabismus surgery is rare. Ch ildren may not recognize or verbalize symptoms. Causative organisms are: vi rulent. Visual and anatomical outcomes are poor. Lethargy, asymmetric eye r edness, eyelid swelling, or fever in the postoperative period, even if init ial postoperative examination results are normal, should prompt urgent ocul ar examination. The diagnosis of endophthalmitis may be made when biomicros copic or indirect ophthalmoscopic examination confirms the presence of vitr eous opacification with or without hypopyon.