Endogenous bacterial endophthalmitis Richard Gale Miles Stanford

Introduction  Floaters and shadows in Left eye for 5 days  6/36 vision left eye, red eye with hypopyon

History  Treated for cellulitis right leg with intravenous augmentin for 1 week  Increasing back, ankle and elbow pain  Awoke with reduced vision and pain in the left eye  Right eye normal, Left 6/36, conjunctival injection, hypopyon vitreous opacities.  T 38.6 BP 161/73 Pulse 80 RR 14/min Splinter haemorrhages, heart sounds normal.

Findings Septic arthropathy Vitreous opacities

INVESTIGATIONS  Blood cultures: Repeatedly no growths Raised white cell count and inflammatory markers Vitreous biopsy and intravitreal vancomycin and cefuroxime IV flucloxacillin 2g 4hrly

At 48 hours

Final diagnosis Staphylococcus aureas grown on vitreous biopsy Vision improved to 6/9

Conclusion Consider the diagnosis in systemically unwell patients with reduced vision and a red eye. Rapid diagnosis and treatment with vitreous biopsy and instillation of antibiotics leads to an improved outcome