Endophthalmitis is a rare intraocular infection characterized by inflammation of the vitreous cavity, with endogenous endophthalmitis resulting from hematogenous spread of pathogens from a systemic infection, accounting for 5–10% of all cases. Prostatic abscess an uncommon condition, typically affects patients with risk factors such as diabetes mellitus and immunosuppression, and is often presents with symptoms including dysuria, urgency, frequency, suprapubic or perineal pain, urinary retention, and tenesmus. While Escherichia coli is the most commonly implicated pathogen, Staphylococcus aureus has also been reported, though rare.

We present the case of a 52-year-old male with poorly controlled diabetes mellitus who developed blurred vision and floaters in the right eye for 4 days, along with urinary symptoms (dysuria, urgency, and hematuria) for months. Ocular examination revealed right eye visual acuity of counting fingers at 10 cm, accompanied by corneal edema, increased anterior chamber cells, exudative membrane, and vitritis, all suggestive of endogenous endophthalmitis. Contrast-enhanced CT identified a septated abscess in both prostate glands. Empirical treatment with ceftriaxone and levofloxacin was initiated, and blood and urine cultures both identified Staphylococcus aureus as the causative organism. The patient underwent trans pars plana vitrectomy followed by multiple intravitreal injections of vancomycin and ceftazidime. After 14 days of parenteral antibiotics, the patient's systemic condition improved, and his vision remained stable.

Endogenous endophthalmitis is a rare and severe ocular infection caused by systemic spread of microorganisms. Common pathogens include Escherichia coli, Staphylococcus aureus, and Klebsiella. Potential sources of infection include the gastrointestinal tract (e.g., hepatic abscess, appendicitis), the genitourinary tract (e.g., renal abscess, infected stones), and other sites such as the heart and ear. Metastatic endophthalmitis from a genitourinary source is particularly rare. In the management of endogenous endophthalmitis, it is crucial to promptly identify all sources of infection, especially in patients with S. aureus bacteremia.

Our case report emphasizes the importance of recognizing the rare presentation of Staphylococcus aureus prostatic abscess associated with rapidly progressing endogenous endophthalmitis. Early detection and aggressive intervention are essential to prevent permanent vision loss.