Neonatal candidiasis: ophthalmologic infection

Endophthalmitis results from hematogenous seeding of the eye in preterm infants with candidiasis. Early systemic therapy decreases the frequency of eye involvement, now only about 6% in infants with systemic candidiasis. Eye disease can occur on the first day, but is more likely with prolonged candidemia. Candida albicans and C tropicalis predominate in newborns. Indirect ophthalmoscopy will identify the characteristic unilateral or bilateral, yellow-white, fluffy, retinal or vitreal balls with frequent hemorrhage or inflammatory vitreous haze. Systemic antifungal therapy alone usually results in good visual outcome, but unresponsive or recurrent lesions are reported. Lens abscesses presenting as cataracts may be seeded before regression of the tunica vasculosa lentis, leaving an infection nidus in a subsequently avascular structure that is poorly reached by antifungal drugs. Lensectomy may be required to clear the visual field and the infection. Candidemia is also implicated in progression of retinopathy of prematurity to stage 3 or beyond, possibly due to induction of cytokines or angiogenic factors.