UMEM Educational Pearls

Category: Critical Care

Title: Fungal Endopthalmitis

Keywords: fungal, endopthalmitis, ocular, critically ill, systemic infection, immunosupression, IVDA (PubMed Search)

Posted: 1/17/2012 by Haney Mallemat, MD
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Fungal endopthalmitis is an intraocular infection of the aqueous and/or vitreous humor secondary to fungal pathogens; Candida and Aspergillus species are the most common pathogens.

Risk factors: intravenous drug abuse (#1 risk factor), critical illness, systemic fungal infection, immunosuppression (from cancer or medications), diabetes, and alcoholism.

Have a high-index of suspicion for endopthalmitis when patients with systemic fungal disease have visual symptoms; endopthalmitis is present in up to 33% of patients with systemic fungal disease.

Symptoms include:

  • Visual disturbances / visual loss
  • Eye pain
  • Photophobia
  • Red eye
  • “Floaters”
  • Asymptomatic

Inspection of both the anterior and posterior chamber is essential to during evaluation; several small yellow-white circular or “fluffy” lesions with surrounding hemorrhage are demonstrated.

Definitive diagnosis made by vitreous biopsy, culture, or PCR; presumptive treatment is acceptable if systemic fungal disease has been demonstrated.

Treatment with Amphotericin B or Voriconazole may be used for broad-spectrum fungal coverage until specific culture and sensitivities return.


Shah CP, McKey J, Spirn MJ, Maguire J. Ocular candidiasis: a review. Br J Ophthalmol. Apr 2008;92(4):466-8.

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