Purpose: To report a case of bilateral endogenous Klebsiella pneumoniae panophthalmitis causing blindness in both eyes without anterior chamber reaction in a previously healthy patient.

Case summary: A 78-year-old woman presented with sudden visual loss in both eyes since 3 days ago. Initial visual acuity was no light perception in both eyes. Intraocular pressure was 52 mmHg/55 mmHg. Anterior chamber depth was very shallow, and 360 degrees posterior synechiae was observed bilaterally. There were no hypopyon and cell in the anterior chamber. The patient had general weakness and abdominal pain since 1 month ago. Liver abscess in the S5 segment and septic emboli in both lungs were noted on the abdominal computed tomography. Brain MRI showed multiple brain abscesses. B-scan sonography showed choroidal thickening and dense haziness in the vitreous cavity. The patient was treated by percutaneous catheter drainage. Bilateral eyelid edema and ocular movement limitation developed on the fifth day after first visit. Paranasal sinus computed tomography showed bilateral panophthalmitis. Klebsiella pneumoniae was cultured in the pus obtained by percutaneous catheter drainage. Bilateral endogenous Klebsiella panophthalmitis was diagnosed. The patient had injection of intravitreal vancomycin and ceftazidime 3 times. However, endophthalmitis was not controlled and finally corneal perforation requiring evisceration occurred in the right eye. The left eye was maintained as phthisis.

Conclusions: Klebsiella panophthalmitis can occur even in a previously healthy patient. Thus, when there are sudden visual loss and eyelid edema, even though there is no anterior chamber reaction, panophthalmitis should be suspected.