Challenges and Management Strategies for Endophthalmitis in Silicone Oil-filled Eyes: A Comprehensive Narrative Review

Abstract

Aims: This narrative review aims to examine current knowledge on the management of endophthalmitis in silicone oil-filled eyes by analyzing therapeutic strategies, clinical outcomes, and the unique challenges associated with this context. Study Design: Narrative review based on critical synthesis of published clinical and experimental literature. Place and Duration of Study: Conducted at the Department of Ophthalmology, University Hospital Hassan II of Fez. The literature analyzed spans from January 2000 to March 2025. Methodology: A Systematic search of the PubMed, Scopus and Google Scholar databases was carried to identify publications written in English or French that specifically addressed endophthalmitis in the context of silicone oil tamponade. Studies included randomized and non-randomized trials, clinical case series, systematic reviews, and cohort studies. only articles that provided detailed information on diagnostic approaches, therapeutic protocols, and clinical outcomes were integrated. A total of 221 publications were initially identified. Data were synthesized narratively. Results:  Although rare, endophthalmitis in silicone oil filled eyes constitutes a major diagnostic and therapeutic challenge. The antimicrobial properties of silicone oil, while suggested by experimental and clinical findings, remain debated and vary depending on the pathogen. Key risk factors include unsutured sclerotomies, combined procedures, and anatomical variables. The clinical presentation is often atypical, complicating early detection. Culture positivity remains low. The mainstay of treatment consists of silicone oil removal, intravitreal antibiotic injection and, in selected cases, reinjection of silicone oil. Pharmacokinetic studies suggest altered antibiotic behavior in oil filled eyes, requiring dosage adjustments. Despite adequate treatment, visual outcomes are often limited. Conclusion: The rapid adaptation of therapeutic based on cultures results, antibiotic sensitivity profiles, and the clinical response remains crucial in the management of infectious endophthalmitis occurring in eyes underwent tamponade by silicone oil. Although available data are mainly derived from retrospective analyzes and isolated cases reports, they highlight the importance of early intervention and tailored management. Larger prospective studies are necessary to optimize diagnostic and therapeutic protocols and improve visual prognosis. Additionally, further research into the antimicrobial properties of silicone oil and the impact of current management strategies on long-term outcomes is needed.