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Published on: February 6, 2021
[Ophtalmoscopic examination in critically ill non-neutropenic patients: Candida endophtalmitis]
1Servicio de Oftalmología, Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain. epblazquez@mi.madritel.es
Abstract:
Invasive Candida (IC) infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within three days and at least two weeks of fungemia. There are two characteristic ocular signs: Candida chorioretinitis defined as retina and choroid lesions without vitreal involvement, and Candida endophthalmitis defined as chorioretinitis with extension into the vitreous with characteristic fluffy balls. The most common initial visual symptoms are blurred vision and floaters. Amphotericin B, fluconazole and voriconazole are effective in the treatment of chorioretinitis; however, when vitreous is involved vitrectomy seems necessary. Early antifungal systemic treatment at first evidence of infection in patients at risk of IC, appears to decrease dramatically the incidence of endogenous fungal endophthalmitis, probably healing minimal chorioretinal infections. Routine ophthalmoscopic examination seems of little value in patients with positive blood culture, with early implementation of antifungal treatment, without symptoms of ocular infection and without impairment of the level of consciousness during the episode. However, periodic ophthalmoscopic examination should be performed in children with candidemia and critically ill patients with documented deep Candida infection.
Insights
Invasive Candida infection, a common cause of endophthalmitis, can be mitigated by early antifungal treatment. Routine eye exams are less valuable unless patients are critically ill or children with candidemia.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Context:
- Invasive Candida (IC) infection is the leading cause of endogenous endophthalmitis.
- Ocular candidiasis manifests as chorioretinitis or endophthalmitis, with symptoms like blurred vision and floaters.
Purpose:
- To review the clinical presentation, diagnosis, and management of ocular candidiasis.
- To evaluate the role of early antifungal treatment and ophthalmoscopic examinations in preventing and managing IC-related endophthalmitis.
Summary:
- Ocular candidiasis presents with retinal/choroidal lesions (chorioretinitis) or vitreous involvement (endophthalmitis). Systemic antifungal therapy (Amphotericin B, fluconazole, voriconazole) is crucial.
- Early systemic antifungal treatment significantly reduces endogenous fungal endophthalmitis incidence, potentially healing early chorioretinal infections.
- Vitrectomy may be necessary for endophthalmitis with vitreous involvement. Routine ophthalmoscopy is less beneficial in stable patients with early treatment, but essential for high-risk groups.
Impact:
- Highlights the importance of prompt antifungal therapy in high-risk patients to prevent severe ocular complications.
- Clarifies the limited utility of routine ophthalmoscopy in certain patient populations while emphasizing its necessity in others.
- Provides guidance on managing invasive Candida infections affecting the eye, improving patient outcomes.
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