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The objective of this study is to explore and compare trends in urban and rural cases of endogenous endophthalmitis (EE) in the United States. This study utilizes data from the 2002–2014 National Inpatient Sample (NIS) Database. Disease diagnoses and procedures were identified using codes from the  International Classification of Diseases, Ninth Revision  (ICD-9). Cases of EE were defined as cases of endophthalmitis in the setting of bacteremia or candidemia without a recent history of ocular trauma. The NIS Database defines urban and rural hospitals based on the hospital county’s population statistics. Statistical analysis was performed using IBM SPSS 23. We identified 8255 cases of EE. Of these cases, 523 (6.3%) occurred in rural areas; 7733 (93.7%) occurred in urban areas. Of the cases of EE, 7692 (93.2%) were bacterial EE, 412 (5.0%) were candida EE, and 151 (1.8%) were mixed EE. Candida EE was observed in 1.7% of rural cases and 5.2% of urban cases (p &lt; .001). Pars plana vitrectomies were performed more often in urban hospitals than in rural hospitals (11.5% vs. 2.9%; p &lt; .001). Endogenous endophthalmitis remains a rare but devastating ocular infection. In this study, we have demonstrated that there are important differences in cases of EE that present to urban and rural hospitals. Future investigations into these differences in patient demographics, source/systemic infections, and hospital courses may allow clinicians and hospitals to develop a more targeted approach to treating EE based on the type of community from which the patient presents.

Trends in Endogenous Endophthalmitis in Rural and Urban Settings in the United States