Endophthalmitis Requiring Enucleation in a Sedated Critically Ill Patient: A Case Report

Endophthalmitis is a rare but sight-threatening ophthalmic emergency that may occur following trauma, surgery, or hematogenous spread of infection. Diagnosis may be particularly challenging in critically ill or sedated patients unable to report visual symptoms. A Caucasian male in his 50s was admitted to the ICU following a motor vehicle collision. During admission, progressive erythematous changes developed around the right eye in the absence of clinically identified ocular trauma, systemic infectious features, or subjective visual symptoms due to ongoing sedation. Computed tomography demonstrated orbital cellulitis with probable endophthalmitis and lens dislocation. Despite urgent ophthalmological intervention, systemic and intravitreal antimicrobial therapy, and orbital decompression, disease progression resulted in corneal perforation requiring enucleation. Early lens dislocation was considered a poor prognostic feature. This case highlights the diagnostic challenge of rapidly progressive endophthalmitis in sedated critically ill patients and emphasizes the importance of vigilant ocular assessment, early specialist involvement, and prompt treatment to minimize irreversible complications.