Bilateral endophthalmitis in a patient with bacterial meningitis caused by Streptococcus pneumoniae

Aim: To present a patient who developed bilateral endogenous endophthalmitis secondary to Streptococcus pneumoniae meningitis. Methods: A 44-year-old man who was unconscious because of bacterial meningitis was referred to us for conjunctival hyperemia and decreased pupillary light reflexes. Ophthalmoscopy revealed inflammation in the anterior chamber and vitreous opacities in both eyes. He was diagnosed as having endogenous endophthalmitis associated with the meningitis. Ceftazidime and vancomycin hydrochloride were injected intravitreally and subconjunctivally repeatedly in both eyes. Results: Vision improved to 20/200 in the left eye 1 month later, but the right eye became hypotonic and blind. Vision deteriorated to light perception in the left eye due to a retinal detachment with proliferative vitreoretinopathy, and vitreous surgery successfully reattached the retina. Vision recovered to 20/80, and the retina has remained attached for 1 year. Conclusions: We recommend that endogenous endophthalmitis be suspected in cases of meningitis, and if present, intravitreal and subconjunctival antibiotics should be promptly given to preserve vision.