Hypopyon

👁️‍🗨️ Hypopyon

🔍 Definition

Hypopyon is the accumulation of white blood cells (pus) in the anterior chamber of the eye, typically forming a visible fluid level that settles inferiorly due to gravity.

🧠 It reflects severe intraocular inflammation, usually from infectious or immune-mediated causes.

 

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📸 Clinical Appearance

• White or yellowish fluid layer in the anterior chamber

• Settles horizontally when upright

• May be sterile (non-infectious) or purulent (infectious)

• Often accompanied by:

  • Redness

  • Pain

  • Photophobia

  • Blurred vision

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🚨 Causes of Hypopyon

🔹 Infectious Causes (Most Common)

Cause	Notes
Corneal ulcer (keratitis)	Especially due to Pseudomonas, Strep, Fusarium
Endophthalmitis	Post-surgery (e.g., cataract), trauma, systemic sepsis
Fungal keratitis	Classically seen in plant-related eye trauma

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🔹 Non-Infectious / Sterile Causes

Condition	Notes
HLA-B27 associated uveitis	Reiter’s, ankylosing spondylitis, etc.
Behçet’s disease	Vasculitis with recurrent uveitis
Sterile post-surgical inflammation	Called "toxic anterior segment syndrome" (TASS)
Intraocular malignancy	Rare — leukemic infiltrates, lymphoma

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🔬 Key Differentiations

Feature	Infectious Hypopyon	Sterile Hypopyon
Pain	Severe	Variable
Redness	Intense	Moderate
Vision loss	Often rapid	Can be mild to moderate
Discharge	Common	Rare
Response to steroids	Worsens condition	Improves symptoms
Systemic illness	Usually absent	Often present (e.g., autoimmune)

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🧪 Diagnostic Workup

Test	Purpose
Slit lamp exam	Assess depth, inflammation, corneal ulcer
B-scan ultrasonography	If fundus view is obscured (r/o endophthalmitis)
Anterior chamber tap	For culture/PCR if infectious cause suspected
CBC, ESR, CRP, HLA-B27	If systemic autoimmune disease suspected
Blood culture, Vitreous tap	In endophthalmitis or systemic signs

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💊 Treatment Overview

🔹 Infectious Hypopyon

• Hospital admission often required

• Intensive topical antibiotics for corneal ulcer (e.g., fortified vancomycin + ceftazidime)

• Intravitreal antibiotics for endophthalmitis

• Avoid corticosteroids initially (can worsen infection)

🔹 Sterile (Inflammatory) Hypopyon

• Topical corticosteroids (e.g., prednisolone acetate 1%)

• Cycloplegics (e.g., homatropine) to relieve pain/spasm

• Treat underlying systemic disease (rheumatologic/autoimmune)

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⚠️ Complications

• Synechiae (iris-lens adhesions)

• Secondary glaucoma

• Corneal decompensation

• Vision loss or blindness

• Phthisis bulbi (shrunken, non-functional eye — in severe cases)

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🔁 Follow-up & Monitoring

• Frequent monitoring (daily if severe)

• Watch for worsening: increasing hypopyon, corneal thinning, perforation

• Adjust treatment based on culture results and clinical response

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👁️‍🗨️ Mnemonic: "HYPOPYON"

• High leukocytes (WBCs in anterior chamber)

• Young adults (often autoimmune)

• Painful red eye

• Opaque fluid level

• Purulent in infections

• Yield cultures/tap if suspect endophthalmitis

• Often urgent

• Never ignore! Refer promptly

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Would you like:

• A visual diagram of hypopyon in slit lamp view?

• A comparison table: Hypopyon vs Hyphema?

• Clinical scenarios to quiz your understanding?