Post-Traumatic Endophthalmitis

Post-traumatic endophthalmitis is a severe eye infection that happens after an eye injury. “Post-traumatic” means it follows trauma, such as a cut, puncture, blast, or any penetrating injury to the eye. “Endophthalmitis” means the germs are growing inside the eye, in the fluid and gel that fill the eye. These germs are usually bacteria or fungi. They can ride into the eye on a dirty object, a small piece of metal, a plant thorn, glass, dust, or water at the moment of injury. They can also enter through an open wound if the wound is not cleaned and closed quickly. Once inside, the germs multiply fast, the body reacts strongly, and the clear eye tissues turn cloudy and inflamed. Vision can drop in hours. This is an emergency that needs urgent specialist care.

The eye has two main inner spaces. The front space has watery fluid. The back space has a jelly gel called the vitreous. Germs can reach either or both spaces. The immune system tries to fight, but the eye is a closed space with little blood flow, so the fight creates pus and debris that block light and damage delicate tissues. If care is delayed, the infection can spread to all layers of the eye and even out into the orbit around the eye. Quick diagnosis and quick treatment are the keys to saving sight.

---

Types

1. Acute fulminant post-traumatic endophthalmitis. The infection starts within hours to a few days after the injury. Symptoms explode quickly. Vision drops fast. Pain is severe. This is often caused by highly aggressive bacteria.

2. Delayed-onset post-traumatic endophthalmitis. The infection starts days to weeks after the injury. Symptoms creep in more slowly. It can happen if a small foreign body remains hidden or if a low-grade germ, such as some fungi, grows slowly at first.

3. Bacterial post-traumatic endophthalmitis. Bacteria cause most cases. Some species from soil and plant material, such as Bacillus cereus, can cause extremely rapid damage. Others, like Staphylococcus or Streptococcus, can vary from moderate to severe.

4. Fungal post-traumatic endophthalmitis. Fungi from plant matter, wood, or dirty water can seed the eye. Symptoms may be more gradual. Fungal infections need different medicines and often longer treatment.

5. Polymicrobial infection. More than one germ is present. A mix of bacteria or bacteria plus fungi can enter together, especially with dirty wounds. Mixed infections are harder to treat.

6. Intraocular foreign body (IOFB)–associated endophthalmitis. A tiny object is stuck inside the eye. It carries germs into the eye or keeps the wound from sealing. Metal, wood, glass, or plastic can all be involved.

7. Open-globe injury–related endophthalmitis. The wall of the eye is cut or torn. Germs have an open doorway to enter. The risk is highest when the wound is large, dirty, or left open for too long.

8. Anterior-segment–predominant endophthalmitis. Most inflammation is in the front part of the eye. The cornea, anterior chamber, and iris look cloudy and inflamed. Pain and light sensitivity are strong.

9. Posterior-segment–predominant (vitritis-dominant). Most inflammation is in the back gel. The vitreous turns hazy and full of pus-like cells. The retina cannot be seen well. Vision is very blurred.

10. Panophthalmitis. The infection spreads through all layers of the eye and into the tissues around the eye. The eye is very painful and swollen. This is life- and sight-threatening and needs urgent hospital care.

11. Culture-positive endophthalmitis. Laboratory tests find the exact germ in samples taken from the eye. Knowing the germ helps tailor the antibiotics or antifungals precisely.

12. Culture-negative endophthalmitis. No germ grows in the lab, but the clinical picture strongly fits infection. Germs may be few, slow-growing, or already partly suppressed by early antibiotics. Treatment still proceeds based on the most likely causes.

---

Causes

1. Penetrating injury with plant material (thorns, sticks, splinters). Plant matter carries soil and fungi that can seed the eye during a puncture.

2. Metallic objects contaminated with dirt (nails, wires, tools). Dirty metal can push bacteria deep into the eye during impact.

3. High-velocity metal fragments from hammering or grinding. Tiny, hot shards shoot into the eye and bring germs with them, especially in workshops without eye protection.

4. Explosive or blast injuries (shrapnel). Mixed debris and high energy cause large wounds that are hard to clean and close quickly.

5. Glass or plastic fragments from accidents. Small, clear pieces can hide in the eye and carry germs in.

6. Fish hooks and marine injuries. Hooks and river or sea water bring unusual bacteria that thrive in water.

7. Animal bites or scratches to the eye. Saliva and claws carry bacteria that can infect a wound.

8. Human bite or fist injuries causing lacerations. Human saliva contains bacteria that can infect eye cuts.

9. Contaminated water exposure at the time of injury. Flood water, ponds, or sewage add a heavy germ load to an open wound.

10. Delay in closing the eye wound. The longer the wound stays open, the more time germs have to enter and grow.

11. Delay in starting antibiotics. Early antibiotics lower risk. Delay allows germs to multiply.

12. Large corneoscleral lacerations with exposed uveal tissue. Deeper tissues offer a rich place for germs to grow if not quickly protected.

13. Rupture of the lens capsule with traumatic cataract. Lens material can leak and feed germs and inflammation.

14. Retained lens fragments after trauma. Fragments can sustain ongoing inflammation and infection.

15. Wearing a dirty contact lens at the time of injury. The lens can trap germs against a new wound.

16. Poor first aid using dirty cloths or non-sterile liquids. Contaminants added during “cleaning” can worsen the infection risk.

17. Diabetes mellitus. High blood sugar weakens immune defenses, so germs gain a foothold more easily.

18. Immune suppression (steroids, chemotherapy, HIV, or other causes). Lowered immunity makes infections more likely and more severe.

19. Rural or farm injuries. Soil-rich environments carry aggressive bacteria and fungi that rapidly damage eye tissues.

20. Unsanitary environment during the first days after injury. Dirty dressings, dust, or contact with unclean water near the wound increase the chance of germs entering.

---

Symptoms

1. Severe eye pain. The eye hurts deeply and constantly. Pain often gets worse quickly.

2. Sudden and marked drop in vision. Vision may fall to only light perception or hand movements.

3. Eye redness. The white of the eye turns very red because blood vessels are inflamed.

4. Extreme light sensitivity. Light causes sharp discomfort because the front of the eye is inflamed.

5. Swelling of the eyelids. The lids puff up as tissues around the eye react to the infection.

6. Tearing. The eye waters a lot as a reflex to irritation and pain.

7. Thick discharge. Pus-like discharge can appear at the lashes or wound edges.

8. A feeling of pressure or fullness in the eye. The eye can feel tight, aching, or heavy.

9. Blurry, hazy, or foggy vision. Inflammation and debris turn the inner eye cloudy.

10. Floaters or moving spots. Clumps of inflammatory cells in the gel cast shadows that you see as spots.

11. Pain with eye movement. Moving the eyes tugs on inflamed tissues and hurts.

12. Headache on the injured side. Pain can radiate to the brow, temple, or cheek.

13. Nausea or vomiting. Severe pain and inflammation can trigger nausea.

14. Fever or chills. Some people feel systemically unwell if the infection is severe.

15. Worsening after a brief improvement. Symptoms that get better for a day and then worsen can signal a smoldering infection coming to the surface.

---

Diagnostic tests

A) Physical exam tests

1. Visual acuity with and without pinhole. You read the smallest letters you can. The pinhole helps focus light and checks whether blur is from infection or refractive error. A sharp drop in acuity raises concern for inner-eye infection.

2. External inspection of eyelids and wound. The doctor looks for cuts, swelling, discharge, and tissue prolapse. A gaping or leaking wound makes infection more likely and guides urgent surgical plans.

3. Slit-lamp examination of the front of the eye. A bright microscope shows cornea, anterior chamber, iris, and lens. The doctor looks for cloudy fluid (hypopyon), inflammatory cells, wound leaks, and lens damage.

4. Dilated fundus exam (indirect ophthalmoscopy), if media is clear enough. The doctor uses special lenses and light to view the vitreous and retina. Haze, clumps, or white retinal lesions suggest infection in the back of the eye.

5. Intraocular pressure (IOP) check—only when safe. Pressure is measured with a gentle device. This is avoided if an open globe is suspected, because pressing on a torn eye can worsen the injury. Abnormal pressure can reflect severe inflammation or secondary glaucoma.

B) Manual bedside tests

6. Swinging flashlight test for a relative afferent pupillary defect (RAPD). The doctor swings a light between eyes to see how pupils react. An RAPD suggests significant retinal or optic nerve dysfunction from severe infection.

7. Ocular motility assessment. You look in different directions. Pain or restriction can indicate spread of inflammation or early panophthalmitis.

8. Confrontation visual fields. You cover one eye and count fingers moving in different areas. Field loss can signal retinal involvement or optic nerve dysfunction.

9. Seidel test for wound leak (performed with caution). A fluorescent dye is applied to the cornea to look for streaming fluid that shows a leak. This test may be deferred until the operating room if the globe is unstable.

C) Laboratory and pathological tests

10. Vitreous tap (vitreous biopsy) for Gram stain and culture. A small sample of gel is drawn with a sterile needle, often just before injection of antibiotics into the eye. The lab identifies the germ and tests which drugs will work.

11. Aqueous humor tap for stain and culture. A tiny sample of the front-chamber fluid is taken. This can detect germs if the vitreous sample is not enough or if the infection is early.

12. Gram stain and cytology. The lab stains the sample to see bacteria under a microscope and looks for inflammatory cells. Rapid results guide immediate drug choices.

13. KOH or calcofluor white stain for fungus. These stains help detect fungal filaments quickly. Fungal detection changes the entire treatment plan.

14. PCR (polymerase chain reaction) for bacterial and fungal DNA. PCR can detect tiny amounts of genetic material even when cultures are negative or slow. This is useful when antibiotics were started early.

15. Blood tests: complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). These show the overall level of inflammation or infection and help monitor response over time.

D) Electrodiagnostic tests

16. Electroretinography (ERG). Sensors measure the electrical response of the retina to flashes of light. A very weak signal suggests the retina is badly damaged, which helps doctors discuss prognosis.

17. Visual evoked potentials (VEP). Sensors on the scalp measure the brain’s response to visual signals. Poor signals suggest severe pathway damage and guide expectations for recovery.

E) Imaging tests

18. B-scan ultrasonography of the eye. Sound waves create pictures when the cornea is too cloudy to see in. The scan shows vitreous opacities, retinal detachment, choroidal detachment, or hidden foreign bodies. It is quick, bedside, and very informative.

19. CT scan of the orbits (thin-slice, non-contrast). CT detects metal and glass, maps the wound, and shows fractures or air. It is the best scan to find metallic foreign bodies fast. MRI is avoided if metal is possible because magnets can move metal and cause harm.

20. Ultrasound biomicroscopy (UBM). High-frequency ultrasound gives detailed images of the front of the eye. It can reveal small anterior foreign bodies, wound tracts, or lens capsule tears that are not visible through cloudy corneas.

Non-Pharmacological Treatments

These are supportive or procedural steps that do not rely on medications. They help protect the eye, limit spread, aid healing, and prepare for definitive treatment. Use them alongside the drug and surgical care listed later.

1. Rigid eye shield (no pressure patch).
   Purpose: Protect the injured eye from rubbing or accidental pressure.
   Mechanism: A hard shell prevents further extrusion of ocular contents and shields the wound.

2. Urgent transfer/admission to a surgical eye unit.
   Purpose: Get definitive care (cultures, intravitreal therapy, vitrectomy) without delay.
   Mechanism: Rapid access to an operating room and retina team improves time-to-treatment.

3. Strict sterile technique for any eye procedure.
   Purpose: Prevent adding new germs.
   Mechanism: Povidone-iodine prep, sterile drape, lids/lashes isolation during procedures reduce inoculum.

4. Vitreous/aqueous sampling (“tap”) before antibiotics when feasible.
   Purpose: Identify the causative organism and its drug sensitivities.
   Mechanism: Culture/PCR of vitreous increases chances of targeted therapy later (even though cultures are sometimes negative). EyeWiki

5. Head elevation (30–45°).
   Purpose: Reduce congestive swelling and discomfort.
   Mechanism: Gravity lowers venous pressure, which can modestly reduce inflammation-related edema.

6. Activity restriction (no heavy lifting/bending/straining).
   Purpose: Avoid wound leakage, vitreous prolapse, and IOP spikes.
   Mechanism: Less Valsalva = less pressure on the globe.

7. No contact lenses and no eye makeup during recovery.
   Purpose: Avoid contamination.
   Mechanism: Reduces external bacterial load near the ocular surface.

8. No swimming, hot tubs, dusty or farm environments during acute care.
   Purpose: Limit exposure to water/soil organisms (including Bacillus).
   Mechanism: Cuts additional inoculation risk.

9. Meticulous hand hygiene before any eye drop instillation.
   Purpose: Prevent re-seeding of germs while you’re being treated.
   Mechanism: Lowers transfer of skin flora into the eye.

10. Protective eyewear during convalescence.
    Purpose: Prevent a second injury while the eye is vulnerable.
    Mechanism: Mechanical barrier against accidental trauma.

11. Cold compress for comfort (brief, gentle, no pressure).
    Purpose: Ease pain and photophobia.
    Mechanism: Mild vasoconstriction and numbing effect without pressing on the globe.

12. Dark, quiet room / sunglasses.
    Purpose: Ease light sensitivity (photophobia).
    Mechanism: Lowers trigeminal stimulation from bright light.

13. Pre-op NPO (nothing by mouth) as advised.
    Purpose: Safe anesthesia if urgent PPV or wound repair is needed.
    Mechanism: Lowers aspiration risk.

14. Early imaging for suspected IOFB (thin-slice CT; gentle B-scan if globe is closed).
    Purpose: Find metallic/organic fragments and plan removal.
    Mechanism: Imaging guides surgery and reduces the nidus for infection. EyeWiki

15. Glycemic optimization in people with diabetes (co-managed).
    Purpose: Better wound healing and immune function.
    Mechanism: High glucose impairs leukocyte activity and collagen remodeling.

16. Smoking cessation support.
    Purpose: Improve healing and reduce infection risk.
    Mechanism: Less vasoconstriction and better oxygen delivery to tissues.

17. Head positioning after surgery as instructed.
    Purpose: If gas/oil tamponade is used, proper positioning stabilizes the retina.
    Mechanism: Physics of buoyant tamponade supports retinal apposition.

18. Scheduled close follow-up (often daily early on).
    Purpose: Catch non-response early and repeat intravitreal therapy if needed.
    Mechanism: Objective monitoring with exam and B-scan. EyeWiki

19. Low-vision counseling if vision does not fully return.
    Purpose: Maximize functional vision and safety.
    Mechanism: Training + devices (magnifiers, contrast aids).

20. Psychological support after trauma.
    Purpose: Address anxiety, sleep problems, or PTSD-like symptoms.
    Mechanism: Counseling and family education reduce stress that can hinder recovery.

---

Core Drug Treatments

Important: Doses below are typical clinical references; your doctor will individualize based on weight, kidney function, cultures, and exam. Do not self-administer. Endophthalmitis is a medical emergency.

1. Intravitreal Vancomycin (1.0 mg in 0.1 mL) — Glycopeptide antibiotic
   Purpose: Empiric coverage of gram-positive bacteria, including MRSA and Bacillus species.
   When/How: Injected into the vitreous at the time of “tap and inject” or at the end of PPV.
   Mechanism: Blocks cell-wall synthesis by binding D-Ala–D-Ala.
   Side effects: Rare retinal toxicity; monitor for inflammation/IOP changes. Standard evidence-based dose. EyeWiki+1NCBI

2. Intravitreal Ceftazidime (2.25 mg in 0.1 mL) — 3rd-generation cephalosporin
   Purpose: Empiric gram-negative coverage (e.g., Pseudomonas).
   When/How: Given with vancomycin intravitreally during urgent care.
   Mechanism: Inhibits bacterial cell-wall synthesis.
   Side effects: Low risk of retinal toxicity; avoid if severe beta-lactam allergy. EyeWiki+1NCBI

3. Intravitreal Amikacin (0.4 mg in 0.1 mL) — Aminoglycoside (alternative)
   Purpose: Substitute for ceftazidime in true beta-lactam allergy.
   Mechanism: Blocks bacterial protein synthesis (30S ribosome).
   Caution/Side effects: Retinal toxicity (macular infarction) risk is higher, so many surgeons avoid it unless necessary. U.S. PharmacistWelcome to RetinaLink

4. Intravitreal Voriconazole (50–100 μg in 0.1 mL) — Azole antifungal
   Purpose: Suspected fungal trauma (vegetative matter, subacute course).
   Mechanism: Inhibits fungal ergosterol synthesis (14-α demethylase).
   Evidence: Case series and reviews support safety at 100 μg/0.1 mL; used when fungi are likely.
   Side effects: Generally well-tolerated intravitreally at these doses. Wiley Online LibraryPMCPubMedKarger

5. Intravitreal Amphotericin B (5–10 μg in 0.1 mL) — Polyene antifungal
   Purpose: Alternative or initial choice for filamentous fungi or yeasts, depending on local practice.
   Mechanism: Binds ergosterol, forms pores in fungal membranes.
   Side effects: Dose-related retinal toxicity possible; dose carefully. Wiley Online LibraryKarger

6. Systemic Vancomycin (e.g., 1 g IV every 12 h in EyeWiki example; weight-based in practice) — Glycopeptide
   Purpose: Trauma-related infections often involve the sclera/soft tissues; systemic therapy is frequently added.
   Mechanism: Cell-wall inhibition; covers MRSA and Bacillus.
   Side effects: Nephrotoxicity, infusion reactions (with IV use). Dose and timing individualized. EyeWiki

7. Systemic Ceftazidime (e.g., 1 g IV every 8 h in EyeWiki example) — Cephalosporin
   Purpose: Gram-negative systemic coverage as adjunct in trauma-related cases.
   Mechanism/Side effects: Cell-wall inhibitor; watch for allergy and renal dosing. EyeWiki

8. Oral Moxifloxacin (400 mg once daily) — Fluoroquinolone
   Purpose: Often used as step-down after IV antibiotics or as adjunct in milder cases; helpful tissue penetration.
   Mechanism: Inhibits DNA gyrase/topoisomerase IV.
   Side effects: Tendon issues, QT prolongation; drug interactions. Evidence of use as adjunct varies by etiology. EyeWiki+1

9. Topical fortified antibiotics or fluoroquinolone
   Examples: Fortified vancomycin 50 mg/mL + ceftazidime 100 mg/mL hourly, or moxifloxacin QID, depending on status.
   Purpose: Reduce anterior chamber bacterial load and protect the wound.
   Mechanism: High local concentrations on the ocular surface.
   Side effects: Surface irritation, allergy. EyeWiki

10. Corticosteroids (controversial and selective use)
    Options: Intravitreal dexamethasone 0.4 mg/0.1 mL at time of antibiotics or systemic/topical steroids.
    Purpose: Reduce destructive inflammation after appropriate antimicrobial coverage is in place.
    Evidence: Commonly used but no clear long-term visual benefit in meta-analyses; avoid if fungal infection is suspected.
    Side effects: IOP rise, delayed wound healing; masking signs if given before antimicrobials. NCBIPMCLippincott JournalsEyeWiki

Technical pearls: Intravitreal injection volumes are typically 0.05–0.1 mL; avoid overfilling the eye (paracentesis may be used). American Academy of Ophthalmology

---

Regenerative / Stem-Cell” Drugs

Short answer: There are no approved “stem-cell drugs” or regenerative injections to treat acute endophthalmitis. Using unapproved “stem cell” eye injections has blinded patients and led to regulatory action. If you see any clinic advertising stem-cell cures for eye infections, that is not evidence-based. Consider clinical trials only, within regulated academic settings. U.S. Food and Drug AdministrationPew Charitable TrustsAmerican Academy of Ophthalmology

That said, in very specific, doctor-controlled situations (for example, a person with systemic immune deficiency), clinicians may use adjuncts to support the body’s defenses. These are not treatments for PTE itself and are not routine:

1. Filgrastim (G-CSF) — boosts neutrophils if someone is severely neutropenic for unrelated reasons. Dose and timing are individualized by hematology; not a PTE drug.

2. Intravenous Immunoglobulin (IVIG) — used for certain antibody deficiencies; not for typical PTE.
   3–6) No approved stem-cell medications for PTE. Avoid commercial “stem-cell” injections; discuss only in the context of regulated clinical trials. U.S. Food and Drug AdministrationPew Charitable Trusts

---

Surgeries

1. Primary Open-Globe Repair
   What: Urgent closure of the entry wound with microsutures.
   Why: Seals the globe, restores anatomy, lowers infection spread; earlier repair (often <24 h) is associated with lower endophthalmitis risk. AAO Journal

2. Pars Plana Vitrectomy (PPV)
   What: Keyhole surgery to remove infected vitreous, pus, and debris; take undiluted cultures; inject intravitreal drugs at the end.
   Why: Decreases germ load and toxins, improves drug penetration, allows IOFB removal, and lets the surgeon address retinal tears/detachment. Classic EVS showed benefit mainly when vision was light perception, but many trauma centers now favor earlier PPV, with newer studies supporting broader use. American Academy of OphthalmologyPMC

3. IOFB Removal
   What: Retrieval of metal/wood/plant fragments from inside the eye.
   Why: Foreign bodies harbor germs and toxins; removal reduces re-infection and inflammation. EyeWiki

4. Lensectomy / Cataract Extraction (when lens capsule is violated)
   What: Remove disrupted lens if contaminated or blocking the view.
   Why: Lowers bacterial load and allows full posterior segment access during PPV.

5. Evisceration/Enucleation (last resort)
   What: Removal of the contents of the eye (evisceration) or the entire globe (enucleation).
   Why: Salvage procedure in eyes with uncontrollable panophthalmitis and no visual potential, to relieve pain and prevent spread.

---

Dietary Molecular Supplements

Supplements do not treat PTE. They may support general immune and ocular health during recovery. Discuss with your clinician—avoid exceeding Tolerable Upper Intake Levels (ULs).

1. Vitamin A (e.g., 700–900 mcg RAE/day; UL 3,000 mcg RAE/day; avoid high doses in pregnancy)
   Function/Mechanism: Epithelial integrity, photoreceptor function; retinoids support barrier defenses. Office of Dietary Supplements+1

2. Vitamin D3 (typical 600–800 IU/day; monitor 25-OH D; UL depends on age, e.g., 4,000 IU/day for most adults)
   Function/Mechanism: Modulates innate/adaptive immunity; may support bone and systemic health during convalescence. Office of Dietary Supplements+1

3. Vitamin C (e.g., 200–500 mg/day from diet/supplements)
   Function/Mechanism: Antioxidant recycling, collagen synthesis for wound healing.

4. Vitamin E (e.g., 100–200 IU/day from diet/supplements, staying under ULs)
   Function/Mechanism: Lipid-phase antioxidant; protects membranes.

5. Zinc (RDA ~8–11 mg/day; avoid long-term high doses; UL 40 mg/day)
   Function/Mechanism: Enzyme cofactor for immunity and wound repair; excessive zinc lowers copper. Office of Dietary Supplements+1

6. Selenium (RDA 55 mcg/day; UL 400 mcg/day)
   Function/Mechanism: Selenoproteins (e.g., glutathione peroxidases) support antioxidant defenses. Office of Dietary Supplements+1

7. Omega-3 (EPA/DHA) (commonly ~500–1,000 mg/day combined; take with food)
   Function/Mechanism: Pro-resolving lipid mediators may help systemic inflammation balance; also supports retinal cell membranes. Office of Dietary Supplements

8. Probiotics (strain-specific; per product label)
   Function/Mechanism: Gut-immune axis support; evidence mainly for reducing antibiotic-associated diarrhea while on systemic antibiotics; avoid in severely immunocompromised patients. Office of Dietary Supplements

9. Lutein (10 mg) + Zeaxanthin (2 mg) — the AREDS2 carotenoid combo for macular support (best-studied in AMD; not a PTE treatment).
   Function/Mechanism: Blue-light filtering, antioxidant in macula; may support retinal health during recovery. National Eye InstituteJAMA Network

10. Balanced Multinutrient Approach
    Function/Mechanism: Hitting RDAs (not megadoses) supports healing. Use clinician-vetted brands and avoid stacking overlapping products that exceed ULs. (NIH ODS has clinician fact sheets for many nutrients.) Office of Dietary Supplements

---

Preventions You Can Actually Do

1. Wear ANSI-rated protective eyewear for high-risk tasks (construction, farming, grinding, fireworks).

2. Fix injuries fast: primary globe repair ideally <24 hours after trauma lowers infection risk. AAO Journal

3. Early IOFB detection and removal if suspected. EyeWiki

4. Peri-repair antibiotic strategies as directed by your surgeon; intravitreal prophylaxis can reduce PTE risk in selected open-globe cases. PMC

5. Avoid self-treating with OTC eye drops after trauma; contamination recalls occur. Seek urgent care. U.S. Food and Drug Administration

6. Keep tetanus vaccination up to date (general trauma prevention).

7. Do not press on an injured eye or try to “rinse it out” if an open globe is suspected—use a shield and go to hospital.

8. Control diabetes and stop smoking to support healing.

9. Use clean water only for facial hygiene while wounds heal.

10. Know the warning signs after trauma: pain, worsening redness, light sensitivity, floaters, sudden blur.

---

When to See a Doctor

• Immediately after any penetrating eye injury or if you suspect an open globe.

• Immediately if, after an eye injury, you have severe pain, rapidly worsening vision, increasing redness, pus, hypopyon (white layer in the front of the eye), or fevers.

• Within hours if symptoms are evolving—even if the original injury seemed “minor.” PTE can progress fast. (Clinicians may do cultures, ultrasound/CT, and proceed to intravitreal antibiotics and early PPV if indicated.) EyeWiki

---

What to Eat” and “What to Avoid

Food won’t cure PTE, but it supports healing while you receive medical/surgical care.

Prioritize 

1. Leafy greens (spinach, kale) for lutein/zeaxanthin.

2. Bright-colored vegetables (carrots, sweet potatoes, bell peppers) for carotenoids/vitamin A precursors.

3. Citrus and berries for vitamin C.

4. Nuts and seeds (almonds, sunflower seeds) for vitamin E.

5. Fatty fish (salmon, sardines) for EPA/DHA.

6. Beans, lentils, poultry for zinc and protein.

7. Eggs (yolks contain lutein/zeaxanthin).

8. Whole grains for steady energy and micronutrients.

9. Yogurt/fermented foods for gut support (unless your clinician advises otherwise).

10. Plenty of water for hydration.

Limit/Avoid 

1. Alcohol (impairs healing).

2. Smoking/vaping (vasoconstriction delays repair).

3. Ultra-processed foods high in sugar/refined starch (pro-inflammatory).

4. Excess salt (swelling/pressure).

5. Energy drinks (stimulants; sleep disruption).

6. Megadoses of supplements beyond ULs (risk of toxicity; clear with your clinician). Office of Dietary Supplements+2Office of Dietary Supplements+2

7. Unpasteurized or high-risk foods if you’re immunocompromised.

8. Herbal products that thin blood (e.g., very high-dose ginkgo) close to surgery unless your doctor approves.

9. Very spicy foods right after surgery if nausea is an issue.

10. Contaminated water/ice from uncertain sources during early recovery.

---

Frequently Asked Questions

1) Is post-traumatic endophthalmitis always bacterial?
Usually yes, but fungi can cause a more delayed, “smoldering” infection—especially after plant/soil injuries. Treatment differs, so doctors consider fungal coverage when appropriate. EyeWiki

2) What antibiotics go into the eye?
The standard empiric combination is vancomycin (1.0 mg/0.1 mL) + ceftazidime (2.25 mg/0.1 mL). If there’s a severe beta-lactam allergy, amikacin (0.4 mg/0.1 mL) may replace ceftazidime, but it carries higher retinal toxicity risk, so many avoid it unless necessary. EyeWikiU.S. Pharmacist

3) Do I still need surgery if I get injections?
Often, yes. In trauma, many surgeons perform early PPV to remove infected material and any foreign body. Emerging studies suggest earlier PPV can improve outcomes beyond classic EVS criteria. PMCAmerican Academy of Ophthalmology

4) What if a Bacillus infection is suspected?
Doctors are extra aggressive; Bacillus can cause hyper-acute damage. They avoid cephalosporins for Bacillus cereus and may tailor therapy accordingly. EyeWiki

5) Are steroids safe?
Sometimes. They may be used after antibiotics to reduce inflammation. Evidence for better long-term vision is mixed, and steroids are avoided if a fungal cause is suspected. PMCLippincott Journals

6) How fast do I need treatment?
Right away. Hours matter. Intravitreal antibiotics and, when indicated, PPV are time-critical.

7) Can oral antibiotics alone fix this?
No. Pills don’t reach high enough levels inside the vitreous. Oral/IV antibiotics are adjuncts; intravitreal therapy is the key. EyeWiki

8) What’s the injection volume? Does too much fluid hurt?
Typical intravitreal doses are in 0.05–0.1 mL volumes; surgeons manage eye pressure (sometimes with paracentesis) to keep the eye safe. American Academy of Ophthalmology

9) Can supplements cure PTE?
No. Supplements can support overall health but cannot replace antibiotics/surgery. Use NIH-vetted guidance to avoid toxicity. Office of Dietary Supplements

10) Is prophylaxis during open-globe repair useful?
Evidence suggests intravitreal prophylaxis during repair can reduce PTE in some high-risk cases; surgeons decide case-by-case. PMC

11) Does early wound repair really matter?
Yes. Studies associate repair within ~24 hours with lower endophthalmitis risk. AAO Journal

12) I saw “stem-cell injections” online for eye disease. Should I try them?
No—not outside a regulated clinical trial. The FDA warns against unapproved stem-cell eye injections; severe harm, including blindness, has occurred. U.S. Food and Drug AdministrationPew Charitable Trusts

13) How long will I be in the hospital?
Many trauma-related cases stay several days for IV antibiotics and close monitoring before switching to oral therapy and frequent outpatient follow-up. EyeWiki

14) Will I get my vision back?
It varies. Prognosis depends on the germ’s virulence, how fast treatment started, initial vision, retinal detachment, and whether an IOFB was present. Early, aggressive care gives the best chance. EyeWiki

15) Can both eyes be affected?
PTE is caused by external inoculation into the injured eye. The fellow eye is usually not infected, but your doctor still examines both eyes carefully.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 22, 2025.