Endophthalmitis due to a retained intraocular metallic object

Endophthalmitis is a sight-threatening infection for which prompt diagnosis and treatment is central to improving patient outcomes. Diagnosing endophthalmitis can be difficult in the emergency department (ED), as its symptoms may be nonspecific and definitive testing equipment is delicate, requiring a high degree of familiarity to operate correctly. We present the case of a 42-year-old man who presented to the ED following a traumatic ocular injury. Fluorescein staining revealed a corneal abrasion. The patient was prescribed erythromycin ointment and a follow-up appointment with outpatient ophthalmology was recommended. Five days later, the patient presented to the ED again complaining of increasing eye pain, inflammation, and blurred vision. Initial examination of the eye revealed chemosis and corneal infiltrate, indicative of endophthalmitis. Repeat fluorescein staining found no corneal abrasion, though a slit lamp exam located a retained metallic foreign body within the anterior chamber. The patient was treated with fluoroquinolone drops and transferred to a comprehensive eye center for aggressive management. This case highlights the importance of comprehensive ocular exam using a slit lamp following ocular trauma. Timely diagnosis and treatment with intravitreal antibiotics are essential to prevent loss of vision.