Case Study: July 2008

A 40 year old presents with a painful left eye and a reduction in vision. There is no history of trauma. On examination, the eye is injected, the cornea is slightly oedematous. However, there is a white mass in the vitreous.

No improvement is seen with treatment. The patient dies a few days later and at autopsy a right-sided endocarditis is seen.

  • Figure 1 shows an image of the eyeball sliced open.
  • Figure 2 shows pathology from the same eye stained with a gram stain.


1. What is the white mass in the vitreous?
2. What is the arrangement of the bacteria in the vitreous on the gram stain?
3. What is the likeliest bacterial species, given the way in which the bacteria are arranged?
4. What is the ophthalmic diagnosis?
5. What is the origin for the cardiac and ocular pathology.

Click to show answers

1. Vitreous abscess.
2. Chains.
3. Streptococci.
4. Metastatic / endogenous streptococcal endophthalmitis.
5. Likely infection of cutaneous recreational drug injection sites.