A Case of Delayed Onset Endophthalmitis

Background: Endophthalmitis is a devastating infection of the eye. It commonly occurs in a post operative setting following intra–ocular surgery or following a ruptured globe and usually occurs within
days of the incident.
Case report: We report a case of delayed endophthalmitis which occurred 57 years following a penetrating injury to the eye. The patient had suffered a penetrating injury to his eye as a child but had made an excellent recovery. Gradually over his lifetime the site of injury had gradually thinned
and following an episode of conjunctivitis had enabled the entrance of pathogenic streptococcal
pneumoniae bacteria leading to endophthalmitis. Previous reports of long delays of developing
endophthalmitis following surgery and trauma have been documented ranging from two to
sixty years but it is very rare to see such a delay. Streptococcal cases of endophthalmitis are less
common in post traumatic cases but are much more common in subacute and late onset post
operative endophthalmitis. We believe this case behaved similar to a late onset post-operative
endophthalmitis with an infected conjunctival filtering bleb usually seen following a trabeculectomy
for glaucoma.
Conclusions: The case demonstrates the long delay which can occur in developing endophthalmitis following a penetrating injury to the eye. The case also highlights the need for patient counselling
following an injury to discuss the possibility of longterm complications. It also highlights that
areas of considerable scleral thinning following an injury may warrant consideration of surgical
intervention to avoid this devastating complication.

Keywords: Eye, Perforating Injury, Endophthalmitis