Tear Metabolomics For Differentiating Bacterial, Viral And Fungal Endophthalmitis.

To identify etiology-specific metabolomic biomarkers in ocular biofluids that differentiate bacterial, viral, and fungal endophthalmitis, enabling earlier diagnosis, improved risk stratification, and more targeted treatment.

Prospectivecase–control study conducted at a tertiary eye-care center.

The study was approved by the institutional ethics committee and performed in accordance with the Declaration of Helsinki .Patients with clinically diagnosed infectious endophthalmitis were stratified by etiology (bacterial/viral/fungal) and clinical severity. Tear and aqueous humor samples were collected and analyzed using ultra-performance liquid chromatography mass spectrometry (UPLC-MS). Multivariate statistical analyses were applied to identify differentially expressed metabolites and pathway-level changes across etiologic groups.

Distinct metabolomic signatures were observed across etiologies. Bacterial endophthalmitis showed increased methyl linolenate, palmitoleamide, and myristoleoyl carnitine. Viral cases demonstrated perturbations in cholesterol- and triglyceride-associated metabolites. Fungal infections displayed sterol pathway alterations consistent with ergosterol-related metabolic changes. These profiles enabled clear separation of groups on multivariate analyses.

Ocular biofluid metabolomics provides etiology-specific molecular signatures that can differentiate bacterial, viral, and fungal endophthalmitis.Tear-based biomarkers, supported by aqueous profiling, complement conventional diagnostics by enabling faster classification and prognostication, potentially guiding earlier targeted therapy and personalized management to improve clinical outcomes.

Financial Disclosure: The authors report no financial or proprietary interests in any material or method mentioned.