Metastatic pneumococcal endophthalmitis: Report of two cases and review of literature

A Prospective Search for Ocular Lesions in Hospitalized Patients with Significant Bacteremia

“…Other risk factors reported to significantly predispose septic patients to ocular involvement include sickle-cell disease, dialysis, asplenia, valvular heart disease, diabetes mellitus, and others [32,52,53,56].…”

“…Many publications recommend routine ocular examination of septic patients [23,32,54,53,45,46,[64][65][66][67]. However, the asymptomatic nature of many of these lesions, their spontaneous remission, and physicians' inability to ameliorate most of them lead us to recommend ocular examination only when a prognosis is sought.…”

“…Articles frequently report single cases with very severe clinical manifestations (such as panophthalmitis [26,32,34,52,53]) or studies based on the practice of direct ophthalmoscopy performed by the attending physician, without involvement of an ophthalmologist.…”

“…In 1923 Seguini [7] reviewed 342 cases of chorioretinitis and endogenous panophthalmitis caused by Streptococcus pneumoniae and b-hemolytic streptococci, and in 1940 Lewis [9] reported 23 cases of meningococcal panophthalmitis among 350 cases of meningococcal infections reported during 1893-1939. Other known ocular manifestations of severe, disseminated infections include orbital cellulitis [10, 11], scleritis [12], optic neuritis [13], choroidal abscess and choroidal infarcts [14-19], arterial retinal obstruction due to septic emboli [20-23], preretinal hemorrhages [22, 24], subretinal neovascularization [16, 25], retinal detachment [26], retinal periphlebitis [27], and others [28-30].Since the introduction of antimicrobial agents, the subject of endogenous ocular lesions in patients with bacteremic infections has been reviewed only occasionally [31][32][33][34]. Most publications to date are either case reports or descriptions of small series of patients, biased by the selection of the more severe forms of ocular involvement or by analysis of selected types of patients or predetermined types of microorganisms.…”

“…Since the introduction of antimicrobial agents, the subject of endogenous ocular lesions in patients with bacteremic infections has been reviewed only occasionally [31][32][33][34]. Most publications to date are either case reports or descriptions of small series of patients, biased by the selection of the more severe forms of ocular involvement or by analysis of selected types of patients or predetermined types of microorganisms.…”