Culture-proven endogenous endophthalmitis: ocular and systemic clinical features and outcomes

To report the clinical presentation, systemic associations, microbiologic spectrum, management strategies, and treatment outcomes of patients with culture-proven endogenous endophthalmitis.

A retrospective review of medical records was conducted of patients with culture-proven endogenous endophthalmitis between 2013 and 2024. Data collected included demographics, systemic and ocular findings, culture results, imaging studies, management strategies, and treatment outcomes.

A total of 50 eyes from 41 patients were identified. Of these, 30/41 (73%) presented in an outpatient setting. The most common presenting symptom was blurred vision in 36/41 (88%) with only 16/41 (39%) presenting with systemic symptoms. Vitreous cultures disclosed fungal organisms in 19/41 (46%) of cases and bacterial in the remainder. Blood cultures were positive in 23/41 (56%). A systemic source of infection was identified in 23/41 (56%), most often associated with indwelling medical devices in 7/23 (30%). Intravenous drug use was present in 7/41 (17%). All patients received intravitreal antimicrobials and 25/50 (50%) underwent vitrectomy. Death associated with systemic infection occurred in only 3/41 (7%) of patients. Evisceration was performed in 2/50 (4%) eyes. Visual acuity at last follow up was ≥ 20/400 in 26/50 (52%) of eyes.

Endogenous endophthalmitis was associated with a fungal source in 46% of cases and was not associated with systemic symptoms in 61% of cases. In the current study, indwelling medical devices remain an important source of infection. Despite prompt treatment, visual outcomes were generally poor.