A 65-year-old man presented with three days of pain and pressure in his right eye, accompanied by blurred vision and photosensitivity. He did not have pain with eye movement. He had a fever and chills. He had a history of poorly controlled diabetes mellitus and a urinary tract infection a week earlier that was treated with ciprofloxacin.

Physical examination revealed a mildly dilated right pupil, with incomplete constriction to light, compared with the left pupil. A small collection of white fluid was observed in the anterior chamber of the right eye (Figure 1).

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

• A. Acute glaucoma.

• B. Behçet syndrome.

• C. Corneal ulcer.

• D. Endogenous bacterial endophthalmitis.

• E. Pseudohypopyon.

Discussion

The answer is D: endogenous bacterial endophthalmitis, an intraocular infection caused by hematogenous spread of organisms from an extraocular location.¹ Findings include decreased vision, eyelid edema, pupillary abnormalities, hypopyon, and conjunctival injection. Diagnosis is based on physical examination and blood culture findings. Intraocular fluid culture from the anterior chamber and vitreous may be needed to confirm the diagnosis if blood culture results are negative.¹ This patient was found to have group B streptococcus bacteremia, confirmed with vitreous culture.