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Endogenous endophthalmitis in a tertiary referral centre: a 14-year case series with comparative perspective

Eye volume 40, pages 123–133 (2026)Cite this article

Subjects

Abstract

Purpose

Endogenous endophthalmitis (EE) is a rare but severe ocular emergency caused by haematogenous spread of infectious microorganisms. This study analyses clinical characteristics, diagnostic challenges, microbiological spectrum, and treatment outcomes of EE cases over a 14-year period, comparing findings with published data.

Methods

A retrospective review was conducted on EE cases diagnosed at a tertiary care centre from 2010 to 2024. Data included demographics, clinical presentation, microbiology, diagnostics, treatment, and visual outcomes. Relevant literature was reviewed to contextualise findings and reflect on similarities and nuances in broader clinical experience.

Results

27 patients with EE were identified. Systemic comorbidities, including malignancies and immunosuppression, were common. Ocular symptoms were present in 77% of cases, while 22% were asymptomatic. The majority exhibited unilateral involvement. Blood cultures (BC) were performed in 77% of cases, with a positivity rate of 66%. Vitreous biopsies were conducted in nine cases, yielding a 66% positivity rate. Treatment included systemic antibiotics or antifungals, topical medications, and intravitreal therapy (81% of cases). Pars plana vitrectomy (PPV) was performed in 51% of cases, though only two underwent early PPV. Final BCVA varied widely, with 59% of eyes achieving functional recovery. 21% of cases resulted in phthisis bulbi or evisceration, and 18% of patients died during follow-up due to systemic illness.

Conclusion

EE presents diagnostic and therapeutic challenges, with high risk of visual impairment and systemic morbidity. Early recognition, aggressive therapy, and timely surgery may improve outcomes. Further research is needed to establish standardised diagnostic and treatment guidelines for optimal management.

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Fig. 1: Case 14. Patient with endophthalmitis in the right eye in the context of a Streptococcus pneumoniae infection resulting from a supraclavicular fasciitis.
Fig. 2: Retinoscopy findings of the right eye (OD) and the left eye (OS) of various patients suffering from endogenous endophthalmitis.

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Data availability

All data generated or analysed during this study are included in this published article.

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Author information

Authors and Affiliations

  1. Ophthalmology Department, Vall d’Hebron University Hospital, Barcelona, Spain

    Elena Ros-Sánchez, David Oliver-Gutiérrez, Rocío García-Risco, Liliana Gutuleac, Paul Buck, Tetiana Goncharova-Simon, Laura Distefano & Eric Kirkegaard-Biosca

  2. Ophthalmology Department, Verte Oftalmología Barcelona, Barcelona, Spain

    Elena Ros-Sánchez, David Oliver-Gutiérrez & Tetiana Goncharova-Simon

  3. Departament de Cirurgia i Ciències Morfològiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Elena Ros-Sánchez & David Oliver-Gutiérrez

  4. Ophthalmology Department, Hospital del Mar | Centre Esperança, Barcelona, Spain

    Liliana Gutuleac

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  1. Elena Ros-Sánchez
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  8. Eric Kirkegaard-Biosca
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Contributions

ER was responsible for collecting the clinical data, drafting the manuscript, and coordinating the overall study. RG and LG collected clinical data from all cases included in the manuscript. DO performed the statistical analysis and contributed to drafting the manuscript. TG and PB gathered the graphical material, reviewed the remaining data from the different cases, and contributed to revising the manuscript. LD, EK, TG and PB critically reviewed and edited the final version of the manuscript. All authors approved the final manuscript for submission.

Corresponding author

Correspondence to Elena Ros-Sánchez.

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Competing interests

The authors declare no competing interests.

Ethics approval

All authors attest that they meet the current ICMJE criteria for Authorship. This study was performed in line with the principles of the Declaration of Helsinki. Patients’ consent was obtained.

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Ros-Sánchez, E., Oliver-Gutiérrez, D., García-Risco, R. et al. Endogenous endophthalmitis in a tertiary referral centre: a 14-year case series with comparative perspective. Eye 40, 123–133 (2026). https://doi.org/10.1038/s41433-025-04121-5

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