[Endogenous bacterial endophthalmitis related to dental abscess: case report].

BACKGROUND

Endogenous bacterial endophthalmitis (EBE) is an intraocular bacterial infection transmitted via a hemotogenous route, usually occuring in immunocompromised patients with bacteremia spreading from extraocular foci of infection. We report a case of EBE secondary to a dental infection occurring in an immunocompetent patient.

METHODS

A 61-year-old-man with no past medical history other than a dental bridge on the 13th tooth was referred for rapid onset hypertensive fibrinous panuveitis of the right eye. He presented with profound visual loss in this eye, an absent pupillary reflex and an obscured fundus. The left eye was normal. Neither fever nor constitutional symptoms were noted at presentation. Work-up revealed a mild inflammatory syndrome with increased C-reactive protein, a high antistreptolysin O titer, and an abscess of the dental bridge. The clinical picture worsened rapidly, suggesting the possibility of EBE secondary to an organism of dental origin. Aqueous humor polymerase chain reaction (PCR) was positive for streptococci, which could not be identified more specifically. Removal of the dental bridge in combination with systemic and intravitreal multiple antiobiotic therapy achieved a rapid cure of the EBE. Vitrectomy combined with phacoemulsification was performed later in order to clear media opacities. At 6 months follow-up, best-corrected visual acuity was 8/10 with no recurrent inflammation.

CONCLUSIONS

This case shows that EBE can occur in the absence of predisposing factors but with an extraocular infectious focus as simple as a dental abscess. In the absence of associated septicemia, with the involved tooth superior and ipsilateral to the affected eye, a spread of the infection by retrograde venous flow should be suspected. The prognosis for visual function may be good if early diagnosis and immediate treatment can be provided.