Review of the literature has shown that certain underlying medical conditions are associated with endogenous endophthalmitis, the most common of which is endocarditis. Transoesophageal Echocardiography showed a mobile echo dense mass on the right coronary cusp of the aortic valve (See Figure 1).Įndogenous endophthalmitis accounts for a small proportion of all cases of endophthalmitis. Investigation revealed elevated inflammatory markers, blood cultures grew Group B Streptococcus and MRI showed a discitis at T11/12 consistent with infection. Examination demonstrated marked tenderness in the lower thoracic region, previously undocumented systolic and diastolic murmurs and signs of pulmonary oedema.

Two days later the patient was readmitted as a medical emergency with symptoms of acute left ventricular failure and worsening lower back pain. Investigation into the source of the sepsis before discharge included an ultrasound of her abdomen, which revealed no intra-abdominal focus. Treatment with intravitreal and systemic antibiotics improved the patient's symptoms and she was discharged. Ocular ultrasound and vitreal biopsy (no growth) enabled a diagnosis of endogenous endophthalmitis to be made.

Conjunctival chemosis was present in the left eye, posterior synechiae and a cloudy vitreous with no fundal view. Initial examination revealed visual acuity in the right eye – 6/9, in the left – finger counting. The patient had no previous medical or ophthalmic history and had been well over the preceding weeks, other than a treated urinary tract infection. A 73-year old lady was referred to the Ophthalmic Accident and Emergency Department with a five-day history of decreased visual acquity and floaters in the vision of her left eye.

Download two red eyes