Dear Editor,

Endogenous endophthalmitis (EE) or metastatic endophthalmitis, is a severe condition with a poor visual prognosis. It results from hematogenous dissemination of bacteria or fungi from a primary infection site to the eyeball ¹.

We report the case of a 69-year-old female with diabetes, hypertension and ischemic heart disease who had undergone colonoscopy due to polyps, three and six months previously. She presented to the Emergency Room due to blurry vision and pain in her left eye (LE) over the last three days and was diagnosed with a vitreous hemorrhage. After 24 hours, the visual acuity (VA) was 0.5 in the right eye (RE), which had a normal fundus. This was lower than 0.05 in the LE, which exhibited chemosis, hypopyon and fibrin in the pupillary area, nuclear cataract, IOP at 45 mmHg and impaired fundus visualization due to the vitreous bleeding (Fig. 1). EE was suspected and the patient received intravenous vancomycin, ceftazidime and fluconazole, plus intravitreal vancomycin, which was repeated after 72 hours. Blood cultures were negative. She had an untoward outcome and required evisceration after ten days. Streptococcus bovis was isolated from the eviscerated material.

Fig. 1 Large chemosis with fibrin in the pupillary area and vitritis that prevents focusing on the eye fundus.