Metastatic pneumococcal endophthalmitis: report of two cases and review of literature.

Two patients with pneumococcal bacteraemia complicated by endophthalmitis are described. While this condition appears to have been relatively common in the preantibiotic era, a review of the literature since 1950 only identified six additional case reports. Analysis of these eight cases reveals two patterns: unilateral disease in six patients and bilateral disease with simultaneous onset in two patients. The potential pathogenic mechanisms--direct bacterial invasion or immunologically mediated processes--are discussed in relation to these clinical presentations. The critical importance of seeking ophthalmological advice early in the course of the disease is emphasised, as the risk of visual loss with systemic antimicrobials alone is very high, particularly if the infective process involves the vitreous humour.