Association of Endogenous Endophthalmitis With Intravenous Drug Use: An Emerging Public Health Challenge

To the Editor We read with great interest the informative and insightful series by Tirpack et al¹ on intravenous drug use (IVDU)–associated endogenous endophthalmitis in New England,¹ which reports 10 eyes of 10 patients over a 2-year period and highlights an increasingly common cause of ocular morbidity. Our 2017 series of IVDU-associated endophthalmitis (fungal and bacterial etiologies) of 32 eyes of 30 patients during an 8-year period also took place in a Boston, Massachusetts, tertiary care eye center but produced some noteworthy differences.² All patients described by Tirpack et al¹ had fungal infections, which was by design because 2 cases with equivocal etiology were excluded. Although IVDU-associated endophthalmitis is classically associated with fungus, clinicians should be mindful of the possibility of bacterial causes because 16% of eyes had a bacterial etiology in our series.² Broad-spectrum treatment should be considered given the potentially catastrophic consequences of untreated bacterial endophthalmitis, with further antimicrobial therapy tailored to patients’ culture results and clinical course.