Endogenous endophthalmitis associated with intravenous drug abuse

Purpose: To describe demographics, characteristics, and management of eyes with endogenous endophthalmitis (EE) in intravenous drug abusers.

Methods: Retrospective chart review of patients with EE who presented to University Hospital, New Jersey Medical School between January 2005 and October 2012.

Results: Thirty-four patients presented with a clinical diagnosis of EE during this time period. Eighteen patients (53%) had a history of intravenous drug abuse with at least 15 of the 18 patients reporting intravenous heroin abuse. Average age was 43 years (24-61 years), 13 were men. Three patients had bilateral involvement. Mean time from the onset of symptoms to presentation was 10 days (range, 1-42 days). Presenting vision in the affected eye ranged from 20/100 to no light perception; the majority of patients had vision of counting fingers or worse. All patients were admitted to the hospital for intravenous antimicrobials and further workup. Final best-corrected visual acuity at the last follow-up ranged from 20/20 to no light perception, with most patients having final vision of 20/400 or worse.

Conclusion: We reviewed 21 eyes of 18 patients with EE and concurrent intravenous drug abuse over an 8-year period; our study shows extremely poor visual prognosis associated with EE in this setting.