Endogenous Klebsiella endophthalmitis

Purpose To report 4 cases of endogenous Klebsiella endophthalmitis. This di sease is a rare but devastating complication of Klebsiella sepsis. Familiar ity with its varied clinical presentations would aid in early diagnosis and institution of appropriate therapy. Methods We report 5 eyes of 4 patients with endogenous Klebsiella endophtha lmitis from December 1995 to September 1996 and review the literature regar ding previously successfully treated cases. Results The mean age of the patients was 67.5 years (range 37-85 years). On e patient had bilateral involvement. At presentation, 3 eyes had a visual a cuity of no perception of light (NPL) and the 1 patient with bilateral invo lvement had an acuity of counting fingers in one eye and 20/40 in the other . The primary source of sepsis was the pulmonary system in 2 patients, the hepatobiliary system in 1 patient and the urinary tract in 1 patient. One p atient had coexisting diabetes mellitus. Two patients had a pupillary hypop yon. Local and systemic treatment with an aminoglycoside and cephalosporin was initiated. Despite treatment, 2 eyes remained NPL. One eye developed a globe perforation and was eviscerated. The patient with bilateral involveme nt was treated within 8 h and recovered fully with a final visual acuity of 20/20 in both eyes. Conclusion It is important to have a high index of suspicion in patients wi th septicaemia presenting with intraocular inflammation, especially in diab etics with suppurative liver disease, urinary tract infection or pulmonary infection. As the visual prognosis for patients with Klebsiella endophthalm itis is generally poor, early diagnosis and treatment with intravenous and intravitreal antibiotics may improve the visual outcome.