Endophthalmitis in Systemic Candidiasis

Pathophysiology and Clinical Presentation

• Endogenous endophthalmitis occurs when pathogens reach the posterior chamber of the eye via hematogenous spread during candidemia, crossing the blood-eye barrier, with Candida albicans being the most common causative organism 1
• The Infectious Diseases Society of America recommends that all patients with candidemia should have a dilated retinal examination, preferably by an ophthalmologist, within the first week of therapy 2

Differential Diagnosis and Risk Factors

• Systemic candidiasis is strongly associated with endophthalmitis due to hematogenous spread of Candida species, according to the Infectious Diseases Society of America 1
• Immunosuppression is a risk factor for Candida endophthalmitis 3
• Prolonged hospitalization and indwelling catheters are also risk factors for Candida endophthalmitis 2

Management Considerations

• The Infectious Diseases Society of America suggests that treatment requires systemic antifungal therapy, and sight-threatening lesions may require intravitreal injection of antifungal agents or vitrectomy 2
• Decisions regarding antifungal treatment and surgical intervention should be made jointly by an ophthalmologist and an infectious diseases physician 2