Candida Endophthalmitis

While Candida causes only 6 % of all culture-positive endophthalmitis cases, the visual consequences of delayed or inappropriate treatment can be devastating. Most cases are endogenous, arising from hematogenous spread during candidemia. These cases manifest either as chorioretinitis alone or also with vitritis. Early infection may be asymptomatic so all candidemic patients should be screened with a dilated funduscopic examination. Among inpatients, major risk factors include an indwelling central venous catheter and an immunocompromising condition. Among outpatients, intravenous drug abuse is the major risk factor. Systemic antifungals are effective for treating most cases of chorioretinitis, but cases with vitritis also require an intravitreal injection of an antifungal agent and may require surgical vitrectomy. Rarely, Candida endophthalmitis occurs exogenously, after eye surgery, trauma, or extension of corneal infection. Treatment must include intravitreal injection of an antifungal agent; vitrectomy is necessary in some cases, and adjunctive systemic azole therapy is given in most cases.