Endophthalmitis caused by Enterococcus faecalis: a case series

Retina. 2009 Feb;29(2):214-7. doi: 10.1097/IAE.0b013e31818eccc7.


Background: To profile the etiology, clinical features, visual and anatomical outcomes in eyes diagnosed with Enterococcus faecalis endophthalmitis.

Methods: A single (tertiary care) center, Retrospective interventional case series. Clinical and microbiological records of 26 consecutive eyes with culture positive E. faecalis endophthalmitis treated at a tertiary referral ophthalmic hospital in south India from 1st January 1995 to September 2007 were reviewed and analyzed.

Results: Of the twenty-six eyes, 12 were of postsurgical etiology, 11 cases were posttraumatic while 3 were of endogenous causes. Two eyes had an intraocular foreign body. Initial mean visual acuity was 3.19 logMAR (range: 0.77-4). All cases were treated with vitrectomy and intravitreal injections. Six cases developed retinal detachment after initial surgery, but only 30.7% eyes had a poor anatomical outcome (8 patients out of 26). All cases except one were sensitive to Vancomycin. Final mean visual acuity was 2.12 logMAR (range: 0.17-4). Paired 't' test showed statistically significant (P = 0.008) good visual outcome (better than or equal to 3/60).

Conclusions: Surgery (12 of 26 eyes) and trauma (11 of 26 eyes) were the commonest causes of E. faecalis endophthalmitis. Our results indicate that early surgical intervention can lead to a good functional outcome despite the virulent nature of the organism. Since almost all the cases were sensitive to Vancomycin, it may be considered as a first line drug in the management of such eyes.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Endophthalmitis / diagnosis
  • Endophthalmitis / drug therapy
  • Endophthalmitis / microbiology*
  • Enterococcus faecalis / isolation & purification*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology*
  • Female
  • Gram-Positive Bacterial Infections / diagnosis
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Retrospective Studies
  • Vancomycin / therapeutic use
  • Visual Acuity
  • Vitrectomy


  • Anti-Bacterial Agents
  • Vancomycin