Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction

Ophthalmology. 2000 Aug;107(8):1483-91. doi: 10.1016/s0161-6420(00)00216-5.


Purpose: To report 32 eyes of 27 patients with endogenous bacterial endophthalmitis seen over a 4 year period. Features and outcomes of this condition in the current series and the cases reported in the literature from 1986-1998 were reviewed.

Design: Retrospective noncomparative case series.

Participants: All patients with this condition seen at the three participating general hospitals were included.

Intervention: A review of the systemic and ocular characteristics, therapeutic methods, and final outcomes in patients afflicted with this condition.

Main outcome measures: Features studied included patients' demographic characteristics, microbiology, source of infection, ocular features, therapeutic interventions, final visual and anatomic outcomes.

Results: Nineteen (70%) of the 27 incriminating organisms in this case series were gram negative microbes, with Klebsiella pneumoniae infections alone being responsible in 16 (60%) cases. Hepatobiliary tract infection was the source of bacteremia in 13 (48%) patients. Only nine (28%) eyes obtained good final visual acuity (20/120 or better), and two eyes were enucleated/eviscerated. A literature review of 209 patients with endogenous endophthalmitis over a 12 year period showed a similar increase in the frequency of gram negative microbes as the responsible organism, especially among the East Asian population. Overall, 22% had bilateral involvement; two thirds of patients had predisposing factor(s) or underlying illness(es), and diabetes mellitus was present in 46%. Thirty-four percent of all eyes obtained counting finger or better final vision, and 16% had their eyes eviscerated or enucleated. Infections with virulent organisms (gram negative rods, Serratia, Bacillus) usually denoted a grave visual prognosis; however, a media that was not opaque on presentation was usually associated with a good prognosis.

Conclusion: Metastatic ocular infection is not uncommon despite the availability of modern antibiotic therapy. Among the East Asian population, the patient at highest risk is a diabetic patient with Klebsiella pneumoniae hepatobiliary infection. In contrast, in the Caucasian population, this condition occurs in predisposed patients with gram-positive bacteremia arising from endocarditis or skin/joint infections. The final visual outcome in patients with endogenous bacterial endophthalmitis in the recent 12 years has not differed significantly from five decades ago.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents
  • Bacteremia / drug therapy
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Child, Preschool
  • Drug Therapy, Combination
  • Endophthalmitis / drug therapy
  • Endophthalmitis / epidemiology
  • Endophthalmitis / microbiology*
  • Eye Infections, Bacterial* / drug therapy
  • Eye Infections, Bacterial* / epidemiology
  • Eye Infections, Bacterial* / microbiology
  • Female
  • Gram-Negative Bacterial Infections* / drug therapy
  • Gram-Negative Bacterial Infections* / epidemiology
  • Gram-Negative Bacterial Infections* / microbiology
  • Gram-Positive Bacterial Infections* / drug therapy
  • Gram-Positive Bacterial Infections* / epidemiology
  • Gram-Positive Bacterial Infections* / microbiology
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Singapore / epidemiology
  • Visual Acuity


  • Anti-Bacterial Agents