Purpose: To report an unusual case of delayed endophthalmitis in a young patient treated for serpiginous choroidopathy. Methods: A single case was reviewed. Results: An 18-year-old patient developed endophthalmitis 3 years after intravitreal (IVT) implantation of fluocinolone acetonide (0.59 mg). The delayed infection was likely secondary to a persistent patent sclerotomy resulting from poor wound healing of the large incision created during implantation. Conclusions: Smaller sclerotomies and additional permanent sutures may help ensure secure closure of implantation wounds and reduce the risk of delayed reopening and subsequent endophthalmitis. Patients should be counseled on the risk of delayed endophthalmitis after implantation of IVT fluocinolone acetonide and advised to seek immediate ophthalmic care if signs or symptoms of infection develop.