# Management of Bilateral Endogenous Methicillin-Sensitive Staphylococcus aureus (MSSA) Endophthalmitis Without Intravitreal Sampling or Injection

## TL;DR

A 70-year-old woman with bilateral eye inflammation caused by a blood infection was successfully treated with just intravenous antibiotics, without needing eye injections.

## Contribution

This case demonstrates that systemic treatment alone can manage bilateral endogenous MSSA endophthalmitis without intravitreal intervention.

## Key findings

- Systemic intravenous flucloxacillin resolved ocular inflammation in a patient with bilateral MSSA endophthalmitis.
- Blood cultures identified the causative organism in this endogenous case, while ocular fluid cultures were not needed.
- Visual acuity improved significantly with systemic therapy alone in one eye and partially in the other.

## Abstract

We report a 70-year-old woman who awoke with sudden, painless bilateral vision loss. Examination revealed dense vitritis, and systemic evaluation found methicillin‑sensitive Staphylococcus aureus septicemia secondary to lumbar facet joint septic arthritis. She received systemic intravenous flucloxacillin without intravitreal sampling or intravitreal antibiotic injection. The ocular inflammation largely resolved, and visual acuity improved to 6/6 in one eye and 6/24 in the other with systemic therapy alone. This case highlights the importance of a thorough systemic workup; blood cultures identify the causative organism in the majority of endogenous cases, whereas ocular fluid cultures yield no growth less frequently. Our experience suggests that when the systemic source of infection is identified and ocular signs are improving, a conservative approach without routine intravitreal tap and inject on presentation may be reasonable. However, treatment should be individualized, and further studies are needed to define the role of intravitreal intervention in endogenous endophthalmitis.