Severe acute endogenous endophthalmitis with Staphylococcus epidermidis in a systemically well patient

Endogenous endophthalmitis is a devastating intraocular infection caused by haematogenous spread of bacteria or fungi, usually in people with immune deficiency. This case report is unusual as a systemically well patient with normal immune function and no identifiable locus of infection rapidly developed a fulminant endogenous endophthalmitis from an organism which does not usually produce aggressive virulence determinants. Endogenous bacterial endophthalmitis is an ongoing diagnostic and therapeutic dilemma for ophthalmologists as it is relatively rare, often initially presents as uveitis, and requires a high index of suspicion for prompt diagnosis and treatment. The treatment of endogenous endophthalmitis is still controversial due to a lack of clinical trials. Potential treatments include systemic antibiotics, peri-ocular injections, intravitreal injection of antibiotics and possibly corticosteroids, pars plana vitrectomy, or a combination of some of these.