Chiasmal enlargement and optic nerve enhancement on magnetic resonance imaging in leber hereditary optic neuropathy.

May and colleagues each reported a case of endogenous endophthalmitis in patients with gingival disease that progressed to an abscess. In the latter case, the patient also had undergone a cavity filling 7 days before onset of symptoms. Our case of endogenous endophthalmitis was in an immunocompetent individual who underwent routine dental cleaning 10 days before seeing an ophthalmologist. She did not undergo any procedures such as cavity filling or tooth extraction on that visit. As noted in previous case reports, periodontal disease is well documented as a potential cause of endogenous endophthalmitis. However, as far as we are aware, this is the first reported case indicating that a routine teeth cleaning without evidence of gingival disease or a focal infection, such as a periodontal abscess, can lead to endogenous endophthalmitis. Because -hemolytic streptococci are known to reside as normal flora in the nasopharynx, we presume that transient bacteremia developed after the dental cleaning, which led to seeding of the organism into intraocular tissues. A lag time of 7 to 10 days before onset of symptoms appears to be consistent with previous reports in the literature. In short, a careful history in any patient with symptoms of uveitis should include inquiries regarding routine dental cleaning.