Metastatic bacterial endophthalmitis.

Metastatic bacterial endophthalmitis has been reported infrequently in the antibiotic era. We recently encountered five cases of metastatic bacterial endophthalmitis during an eight-month period. The diagnosis was made by blood culture in four of the cases and a positive vitreal aspirate in the fifth case. The organisms included: Staphylococcus aureus, Streptococcus pneumoniae, and groups G and B streptococci. Underlying diseases included endocarditis, lymphoma, and facial trauma. One patient had no identifiable source of infection. The diagnosis was delayed in two of the patients, despite early ophthalmologic consultation. The outcome was poor, four of the five patients lost all useful vision. Development of eye symptoms in the setting of gram-positive bacteremia should be suggestive of this entity. An aggressive diagnostic and therapeutic approach with intravitreal antibiotics might improve the outcome. Our observation of five cases during eight months in one hospital suggests that metastatic endophthalmitis may be more common than is generally appreciated.