Delayed-onset endophthalmitis is a well-recognized complication of glaucoma filtering surgery, but, to our knowledge, no previous reports have associated this entity with occult nasolacrimal duct obstruction.
A 16-month-old girl developed endophthalmitis 1 month after a mitomycin-C trabeculectomy for congenital glaucoma. A diagnostic pars plana vitrectomy, anterior chamber paracentesis, and injection of intravitreal antibiotics were performed.
Streptococcus pneumoniae was cultured from the aqueous and vitreous samples. Gradual clearing of the infection was achieved with systemic, intravitreal, and topical antibiotic therapy. Examination following resolution of the infection revealed complete obstruction of the ipsilateral nasolacrimal duct.
The high incidence of Streptococcus pneumoniae as the causative organism in delayed-onset endophthalmitis following glaucoma filtering surgery may be related, in part, to preexisting lacrimal outflow obstruction. Careful preoperative evaluation with attention to lacrimal outflow disorders is imperative prior to glaucoma filtering surgery, especially in children.