Gong Jing Jing, Perkins William, Frenkel Jerry, Greco Jeff, Desmond-Combs Kallie
Department of Emergency Medicine New York Presbyterian Queens Hospital Flushing New York 11355 USA.
J Am Coll Emerg Physicians Open. 2022 Sep 10;3(5):e12802. doi: 10.1002/emp2.12802. eCollection 2022 Oct.
Endophthalmitis is a bacterial or fungal infection in the deep spaces of the eye. The diagnosis of endophthalmitis has traditionally been made by vitreous humor culture and is commonly missed on initial presentation. In this case report, we emphasize the role of ocular point-of-care ultrasound (POCUS) in revealing endophthalmitis as a primary differential diagnosis for a patient presenting with unilateral eye pain and significant swelling that limited physical examination of the eye. Here, the patient's initial clinical examination was more suggestive of an alternative diagnosis, orbital cellulitis, which could have delayed the highly morbid and time-sensitive diagnosis of endophthalmitis. Although POCUS is traditionally enlisted for other posterior ophthalmic pathologies, including retinal detachment, vitreous detachment, vitreous hemorrhage, and papilledema, this rare case of endophthalmitis secondary to hepatic abscess demonstrates the utility of bedside ocular ultrasound as a tool to distinguish endophthalmitis from mimicking differentials when physical examination is unable to do so.
眼内炎是一种发生在眼深部间隙的细菌或真菌感染。传统上，眼内炎的诊断是通过玻璃体腔培养来进行的，在初次就诊时通常会被漏诊。在本病例报告中，我们强调了床旁眼部超声（POCUS）在将眼内炎作为主要鉴别诊断方面的作用，该患者表现为单侧眼痛和明显肿胀，限制了对眼部的体格检查。在此，患者的初始临床检查更提示为另一种诊断，即眼眶蜂窝织炎，这可能会延迟对眼内炎这种高致残性且对时间敏感的诊断。尽管传统上POCUS用于其他后部眼科疾病，包括视网膜脱离、玻璃体脱离、玻璃体出血和视乳头水肿，但这例继发于肝脓肿的罕见眼内炎病例表明，当体格检查无法做到时，床旁眼部超声作为一种工具可用于区分眼内炎与类似的鉴别诊断。
