Ocular coccidioidomycosis

Coccidioidomycosis has been recognized as a common systemic disease since the late 1930's. The occurrence of ocular lesions associated with the systemic infection is uncommon. The anterior segment manifestations appear to be a mild hypersensitivity response; the disease may present as a chronic granulomatous iridocyclitis. In the posterior eye, the manifestations may range from asymptomatic focal chorioretinitis (somewhat similar to the peripheral atrophic lesions of the ocular histoplasmosis syndrome) to a fulminating granulomatous process involving the entire eye. The ocular lesions can occur in the asymptomatic form of systemic coccidioidomycosis. Diagnosis may be confirmed by skin tests and serologic tests. Amphotericin B is usually the drug of choice when treatment is required; however, its adverse effects may be severe, and other drugs, notably Miconazole and Ketoconazole, are being investigated as potential alternatives.