Signs include Intense conjunctival hyperemia and intraocular inflammation within the anterior chamber and vitreous Loss of the red reflex Eyelid edema (occasionally) Diagnosis of Endophthalmitis Clinical evaluation Microbiologic testing (eg, gram stain and culture of aspirates for endogenous endophthalmitis, blood and urine cultures) Diagnosis requires a high index of suspicion in at-risk patients, especially those with recent eye surgery or trauma.