Endogenous Endophthalmitis Secondary to Prostate Abscess

Endophthalmitis is a severe ophthalmic emergency that necessitates immediate intervention. Most cases are exogenous, originating from eye surgeries, intravitreal injections, or penetrating injuries. Endogenous endophthalmitis occurs when the infection is spread hematogenously, usually as a result of bacteremia. We present a healthy individual with no predisposing factors who presented to the emergency department with decreased left vision.  A male in his late sixties with a medical history of hypertension and hyperlipidemia presented to the ophthalmology clinic with complaints of left eye pain, redness, and decreased vision. Diagnosis of endogenous endophthalmitis was made through fundoscopy, and the patient received intravitreal injections of vancomycin and ceftazidime in the left eye. He was subsequently admitted to the hospital, where blood and urine cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Upon further investigation, the patient reported experiencing obstructive urinary symptoms, prompting the initiation of intravenous (IV) vancomycin and linezolid. CT of the abdomen and pelvis revealed multiple prostatic abscesses. During treatment, the patient's vision gradually improved, and he was discharged with IV antibiotics. This case emphasizes the importance of prompt diagnosis and treatment in managing this ophthalmologic emergency. A thorough review of systems was essential in identifying the source of bacteremia, enabling timely intervention. We describe the role of magnetic resonance imaging in diagnosing endophthalmitis and highlight the treatment modalities.