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Although no actual orbital mass has been found yet, we are treating her case as enophthalmos associated with scirrhosing breast carcinoma; she may, however, have spontaneous orbital fat atrophy, triggered by the cancer.

A case of metastatic endophthalmitis due to Clostridium perfringens originating from the biliary tract is reported. The grave visual prognosis and the importance ofearly detection and treatment ofthe primary source ofinfection are emphasised. On the following day proptosis and corneal haze had increased. Details of the anterior chamber were obscured. Cultures from the conjunctiva, urine, and blood were sterile. Ultrasound examination (Figs 1 and 2), performed 24 hours after presentation, showed gross thickening of the choroid, with a large collection of subretinal fluid in the inferotemporal quadrant. Later in the day the globe perforated at the limbus. Evisceration was performed. The evisceration specimen grew a massive culture of Cl perfringens, sensitive to metronidazole, penicillin, ampicillin, and cloxacillin. The patient was treated with intravenous benzylpenicillin 600 mg four times daily.Ultrasound examination of the abdomen confirmed an enlarged gall bladder. A laparotomy performed 9 days after presentation, revealed an acutely inflamed gall bladder. Within the bladder were multiple stones and debris, and the mucosal surface had several ulcers. The bile was sterile, probably due to the antibiotic treatment. The recovery from surgery was uncomplicated.