[Endophthalmitis with keratitis-how to manage severe cases? : A narrative review]

Endophthalmitis secondary to microbial keratitis (MK) is a rare but devastating ophthalmic emergency characterized by diagnostic and therapeutic challenges due to poor corneal clarity. Although it accounts for less than 10% of cases of exogenous endophthalmitis, it often results in poor visual outcomes or enucleation. The most common causative organisms include Staphylococcus spp., Pseudomonas spp., and Fusarium spp., with rising concerns about antimicrobial resistance. Several risk factors have been identified, including the use of topical corticosteroids, systemic immunosuppression, and fungal infections, particularly those caused by Fusarium. Early and aggressive management is essential, combining intravitreal antimicrobials with surgery to reduce the microbiological load. When corneal opacity limits visualization, a combined approach involving temporary keratoprosthesis, penetrating keratoplasty, and pars plana vitrectomy may offer a chance to salvage the eye. This narrative review synthesizes the current understanding of MK-associated endophthalmitis and presents updated management strategies to optimize visual and anatomical outcomes in these severe cases.