Ocular Complications of Endocarditis


Ozlem Sahin






Cardiac complications are the most common complications in patients with infective endocarditis, and they can be related to significant mortality and morbidity. (1) Extra- cardiac manifestations along with their historical descriptions such as splinter hemorrhages, emboli, Osler’s nodes, Janeway and Bowman lesions of the eye, Roth’s spots, patechiae and clubbing generally result from thromboemboli or septic emboli. (2) Inflammatory complications may occur as a result of septic emboli, and these include endogenous (metastatic) endophthalmitis, focal abscess, and vasculitis. (3) In this chapter we mainly focus on the endogenous endophthalmitis arising as a complication of infective endocarditis. Endogenous (metastatic) endophthalmitis is an inflammatory condition of the intraocular structures including the aqueous, iris, lens, ciliary body, vitreous, choroid and retina. (4-6) It results from the hematogenous spread of organisms from a distant source of infection, most commonly infective endocarditis, gastrointestinal tract and urinary tract infections and wound infections. (7-9) Other sources of infection have included pharyngitis, pneumonia, septic arthritis and meningitis. (10,11) Compared with endophthalmitis following trauma or surgery, endogenous endophthalmitis is relatively rare, accounting 2-8% of all reported endophthalmitis cases. (5) However, endogenous endophthalmitis carries with it the danger of bilateral infection in 15-25% of cases. (6,12)