Background <p>Management of endophthalmitis presenting with NLP (no light perception) vision remains poorly defined, with limited evidence guiding treatment decisions. We aim to investigate whether treatment with intravitreal antibiotics reduces the rate of enucleation or evisceration of eyes presenting with exogenous or endogenous endophthalmitis and NLP vision.</p> Methods <p>Retrospective chart review of patients who presented with endophthalmitis and NLP vision between 2010 and 2020 at a tertiary referral center. Main outcome measures were the proportion of patients receiving intravitreal antibiotics or enucleation/evisceration (ENEV) as initial treatment and the rate of globe preservation in patients who received intravitreal antibiotics.</p> Results <p>28 eyes of 26 patients presented with endophthalmitis and NLP vision. The majority of eyes (18/28) were initially treated with intravitreal antibiotics with the aim of globe preservation. Of these 18 eyes, a majority (11/18) achieved globe preservation and the remainder underwent secondary ENEV. Eyes with endogenous and exogenous endophthalmitis that were treated with intravitreal antibiotics achieved similar rates of globe preservation (54% and 57%, respectively). After intravitreal antibiotics, vision in one eye improved to light perception and underwent pars plana vitrectomy to maintain vision. Ultimately, however, the final recorded visual acuity in all eyes was NLP. Additionally, two eyes that received intravitreal antibiotics eventually suffered from phthisical changes, although there was no pain associated with these cases.</p> Conclusion <p>In eyes with NLP vision and endophthalmitis, treatment with intravitreal antibiotics leads to a meaningful rate of globe preservation, however the medical decision making in these cases is complex, requiring consideration of the clinical scenario and the patient’s preferences.</p>