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Metastatic bacterial endophthalmitis. A report of four cases all leading to blindness
Y Piczenik1, B Kjer, H C Fledelius
1University Eye Clinic, Rigshospitalet, Copenhagen, Denmark.
Purpose:
To draw attention to the rare but severe entity of endophthalmitis as encountered due to metastatic spread of bacteria.
Methods:
We report our experience from four cases of metastatic bacterial endophthalmitis.
Results:
Systemic infection (Pneumococcus meningitis) was evident in two cases, but in the other two there was no early clue to systemic infection. Eventually, however, endocardial vegetations were disclosed as the source of bacterial emboli (E.coli, peptostreptococcus). In the most atypical patient, magnetic resonance scanning had indicated disseminated brain tumours, and only autopsy revealed the infectious nature of the disease. Ocular ultrasonography being part of the work-up, the four eyes under study all showed marked morphological intraocular changes, including 'solid tumour' in the presumed neoplastic case.
Conclusion:
Our cases stress the severity of metastatic bacterial endophthalmitis and the easily missed early diagnosis, even where experienced clinicians are involved. The role of diagnostic ultrasound is discussed.