Enterococcus faecalisEndogenous Endophthalmitis from Valvular Endocarditis

Abstract

We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

BacillusPanophthalmitis with Posterior Extension to the Prechiasmatic Optic Nerve

“…In the absence of trauma, a recent history of intravenous drug use should alert the physician to signs of symptoms of panophthalmitis to consider Bacillus as a possible etiology. Furthermore, a hyphema in an IV drug user should arouse suspicion for a serious endogenous infection such as Bacillus or valvular endocarditis due to Enterococcus faecalis [12]. …”

The Antimicrobial Effect of Gold Quantum Dots and Femtosecond Laser Irradiation on the Growth Kinetics of Common Infectious Eye Pathogens: An In Vitro Study

“…If left untreated, ocular infections can damage the structures of the eye resulting in blindness and visual impairments [ 5 ]. The most threatening ocular infections are those affecting the cornea (keratitis) or the eyeball (endophthalmitis) [ 6 ]. Bacterial keratitis is the main cause of corneal blindness [ 5 ], while endogenous bacterial endophthalmitis (EBE) is an inflammatory reaction in intraocular fluids or tissues, and it is one of the most serious complications of ophthalmic surgery [ 6 , 7 , 8 ].…”

“…The most threatening ocular infections are those affecting the cornea (keratitis) or the eyeball (endophthalmitis) [ 6 ]. Bacterial keratitis is the main cause of corneal blindness [ 5 ], while endogenous bacterial endophthalmitis (EBE) is an inflammatory reaction in intraocular fluids or tissues, and it is one of the most serious complications of ophthalmic surgery [ 6 , 7 , 8 ]. Different bacterial pathogens produce different risk levels for ocular infection [ 9 , 10 ]; these infections can be mono- or polymicrobial [ 5 ].…”

Comment on “Intravitreal Ampicillin Sodium for Antibiotic-Resistant Endophthalmitis:Streptococcus uberisFirst Human Intraocular Infection Report”

“…On the other hand, infections caused by E. faecalis are largely described in the literature [ 11 – 17 ]. E. faecalis is known to represent a virulent pathogen frequently associated with endophthalmitis with very poor clinical prognosis [ 14 , 18 ]. Endophthalmitis caused by E. faecalis has been described in a diabetic patient after biliary surgery [ 19 ], while other reports described ocular infections after cataract extractions [ 20 – 22 ].…”