Highlight
• Endogenous endophthalmitis presents with distinct clinical features and outcomes depending on the causative microbial pathogen.
• Gram-negative infections, especially Serratia, carry a significantly higher risk of enucleation and poor visual prognosis.
• Fungal infections are more common in immunosuppressed patients and intravenous drug users, with relatively better presenting and final visual acuities.
• Low intraocular culture yields and imperfect concordance with blood cultures complicate pathogen-directed treatment decisions.
