Bilateral Endogenous Endophthalmitis As a First Presentation of <i>Streptococcus pneumoniae</i> Endocarditis

<b>Purpose:</b> To present a case of bilateral endogenous endophthalmitis as the first presentation of endocarditis. <b>Methods:</b> A single case was evaluated. <b>Results:</b> A 64-year-old Black woman presented with rapidly progressive bilateral vision loss. The visual acuity was no light perception (NLP) OD and LP OS. The initial diagnosis of infectious endophthalmitis was confirmed by a blood culture positive for <i>Streptococcus pneumoniae</i> and an echocardiogram that indicated endocarditis. Despite treatment with intravitreal antibiotics and vitrectomy, the patient's visual prognosis remained poor. <b>Conclusions:</b> Although in general the visual prognosis for <i>S pneumoniae</i>-related endogenous endophthalmitis is poor, early detection and identification of the primary infection source are crucial and can significantly improve the chance of the patient's survival.