ANN OPHTHALMOL. 2001; 33(2):148–150 148 Reprints: Eran Pras, MD, Department of Ophthalmology, Meir Hospital, Sapir Medical Center, 44281 Kfar-Saba, Israel. The authors are from the Department of Ophthalmology, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel. CASE REPORT 148 E ndogenous bacterial endophthalmitis (EBE) is an uncommon intraocular infection caused by hematogenous spread of microorganisms to the eye from extraocular sites, such as the heart, urinary tract, or cerebral meninges. 1,2 Usually the systemic disease presents before the ocular disease, as endocarditis, urinary tract infection, or meningitis. 2 A visual distur- bance is the most common complaint leading these patients to an ophthalmic evaluation and the diagno- sis of ocular involvement. Prompt diagnosis and aggressive treatment are required because EBE is a vision-threatening disease, and its causes are often life-threatening conditions. 1-4 We herein report 2 cases of acute endophthalmitis caused by undiagnosed infectious endocarditis. Aware- ness of the potential sources of endogenous endoph- thalmitis and the urgent need for accurate diagnosis and systemic therapy may save the patient’s life. Report of Cases Case 1. A 59-year-old man was admitted on February 2, 1998, to the emergency room complaining of pain- less acute visual loss in his left eye during the past day. There was no ocular redness, discharge, photo- phobia, or any other ocular symptoms. The patient denied previous eye diseases or trauma to the eye. Before his current disease he was generally healthy, except for mild type 2 diabetes mellitus controlled by diet only. During the 2 months before his admission, he had had intermittent daily fevers (body tempera- tures up to 39.5°C) accompanied by chills, malaise, and Eran Pras, MD, Alexander Rubowitz, MD, Joseph R. Ferencz, MD, Judith Raz, MD, Y. Rotenstreich, MD, & Ehud I. Assia, MD Endogenous Endophthalmitis as the Leading Sign of Endocarditis Endogenous bacterial endophthalmitis is an uncommon intraocular infection caused by hematogenous spread of bacteria from else- where in the body. The ocular infection usually is manifested in patients with already diagnosed systemic disease. We report 2 cases of acute endophthalmitis caused by undiagnosed infectious endo- carditis. Multiple preretinal white dots, resembling bacterial colonies, were seen in 1 eye. Severe infectious endophthalmitis without ocular trauma or surgery may be the first sign of a life- threatening systemic infection. ABSTRACT