Neonatal Endogenous Endophthalmitis Complicated by Spontaneous Globe Rupture: A Case Report

BACKGROUND This report presents a case of endophthalmitis complicated by spontaneous globe rupture to raise awareness concerning early signs of these extremely rare complications of sepsis in the neonatal population and to highlight key clinical management considerations, including prompt ophthalmologic evaluation, B-scan ultrasonography, intravitreal antibiotics, systemic antimicrobial therapy, and expedited planning for vitreoretinal and oculoplastic surgical interventions. CASE REPORT A neonate born at 22 weeks of gestation experienced clinically significant deterioration during week 7 of life due to sepsis and multisystem organ failure. During this period, drainage from the right eye was observed and initially suspected to represent conjunctivitis, prompting topical antimicrobial therapy. However, closer examination indicated that the extruded material likely represented the crystalline lens, vitreous humor, and choroidal tissue. B-scan ultrasonography demonstrated suspected bilateral intraocular infection with globe rupture of the right eye. Infectious studies revealed negative blood cultures, negative ocular specimen cultures, and positive cytomegalovirus testing. The infant ultimately succumbed to the systemic disease process before vitreoretinal surgical intervention could be performed. CONCLUSIONS Signs of endogenous endophthalmitis may be difficult to recognize in premature or low-birthweight infants; however, this diagnosis should be considered and prompt ophthalmologic evaluation pursued in the setting of systemic infection accompanied by new ocular manifestations. Comprehensive reviews of endogenous endophthalmitis cases with rare complications, including spontaneous globe rupture, are needed to promote earlier recognition and intervention in the neonatal population.