Beyond the culture plate: Clinical and therapeutic determinants of endophthalmitis outcomes

The purpose is to evaluate demographic, clinical, and therapeutic factors influencing visual outcomes in exogenous endophthalmitis managed without routine microbiological work-up. This retrospective observational study included 299 eyes diagnosed with exogenous endophthalmitis at a tertiary eye care center between 2014 and 2023. Cases were categorized as traumatic ( n = 148) or nontraumatic ( n = 151). Demographic characteristics, treatment modalities, and final visual outcomes were analyzed. Visual success was defined as final visual acuity (VA) ≥6/60. Trauma-related endophthalmitis accounted for 49.5% of cases and occurred at a significantly younger age than nontraumatic disease (27.6 ± 20.1 vs. 59.4 ± 14.0 years). Pediatric patients constituted 40.5% of traumatic cases compared with 2.6% of nontraumatic cases. Combined intravitreal injection and vitrectomy was the most common intervention (45.8%). Overall, 24.1% of eyes achieved VA ≥ 6/60. Visual success was higher in iatrogenic cases than traumatic cases (32.1% vs. 18.2%). Pediatric patients demonstrated poorer outcomes than adults (10.9% vs. 27.7%). Vitrectomy-based treatment achieved superior outcomes compared with intravitreal injection alone. Traumatic endophthalmitis disproportionately affects younger and pediatric patients and carries a poorer visual prognosis. Early intervention and vitrectomy-based management improve outcomes. In resource-constrained settings, prompt empiric therapy without routine microbiological work-up appears to be a pragmatic and effective management strategy.