Management of Bilateral Endogenous Methicillin-Sensitive Staphylococcus aureus (MSSA) Endophthalmitis Without Intravitreal Sampling or Injection

We report a 70-year-old woman who awoke with sudden, painless bilateral vision loss. Examination revealed dense vitritis, and systemic evaluation found methicillin‑sensitive <i>Staphylococcus aureus</i> septicemia secondary to lumbar facet joint septic arthritis. She received systemic intravenous flucloxacillin without intravitreal sampling or intravitreal antibiotic injection. The ocular inflammation largely resolved, and visual acuity improved to 6/6 in one eye and 6/24 in the other with systemic therapy alone. This case highlights the importance of a thorough systemic workup; blood cultures identify the causative organism in the majority of endogenous cases, whereas ocular fluid cultures yield no growth less frequently. Our experience suggests that when the systemic source of infection is identified and ocular signs are improving, a conservative approach without routine intravitreal tap and inject on presentation may be reasonable. However, treatment should be individualized, and further studies are needed to define the role of intravitreal intervention in endogenous endophthalmitis.