Epidemiology, clinical manifestations, and diagnosis of fungal endophthalmitis
- Marlene L Durand, MD
Marlene L Durand, MD
- Associate Professor of Medicine
- Harvard Medical School
- Carol A Kauffman, MD
Carol A Kauffman, MD
- Section Editor — Fungal Infections
- Professor of Internal Medicine
- University of Michigan Medical School
- Veterans Affairs Ann Arbor Healthcare System
- Section Editors
- Kieren A Marr, MD
Kieren A Marr, MD
- Section Editor — Compromised Host Infections; Fungal Infections
- Professor of Medicine and Oncology
- Johns Hopkins University School of Medicine
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
Fungal endophthalmitis due to yeasts (eg, Candida albicans) differs from that due to molds (eg, Aspergillus or Fusarium spp). Yeast-associated endophthalmitis is usually endogenous (secondary to fungemia), and treatment is often successful, whereas mold endophthalmitis is usually exogenous (occurring after trauma, surgery, or keratomycosis) and often results in permanent loss of vision.
The epidemiology, pathogenesis, clinical features, and diagnosis of fungal endophthalmitis will be reviewed here. The management of fungal endophthalmitis is discussed separately; bacterial endophthalmitis, Fusarium keratitis, and candidemia and other types of Candida infections are also presented elsewhere. (See "Treatment of endogenous endophthalmitis due to Candida species" and "Treatment of exogenous endophthalmitis due to Candida species" and "Treatment of endophthalmitis due to molds" and "Bacterial endophthalmitis" and "Mycology, pathogenesis, and epidemiology of Fusarium infection", section on 'Keratitis' and "Treatment of candidemia and invasive candidiasis in adults" and "Overview of Candida infections".)
The term "endophthalmitis" means bacterial or fungal infection within the eye and usually implies infection of the vitreous and/or aqueous (figure 1).
Endogenous fungal endophthalmitis — Endogenous fungal endophthalmitis results from fungal seeding of the eye via the bloodstream. In most cases, the highly vascular choroid is seeded first. As a consequence, endogenous fungal endophthalmitis often presents with choroiditis or chorioretinitis (infection localized to the choroid or the choroid and retina), with minimal inflammation in the vitreous or aqueous. As the infection worsens, marked vitritis develops and the aqueous may also become involved.
The distinction between fungal choroiditis or chorioretinitis and endophthalmitis (ie, with marked vitritis) is important for making decisions about treatment, and we will specify the degree of involvement in the discussion below.
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- Endogenous fungal endophthalmitis
- Exogenous fungal endophthalmitis
- EPIDEMIOLOGY AND RISK FACTORS
- Candida endophthalmitis
- - Endogenous Candida endophthalmitis
- - Exogenous Candida endophthalmitis
- Mold endophthalmitis
- - Endogenous mold endophthalmitis
- - Exogenous mold endophthalmitis
- Endogenous endophthalmitis
- Exogenous endophthalmitis
- CLINICAL MANIFESTATIONS
- Endogenous fungal endophthalmitis
- Exogenous fungal endophthalmitis
- OPHTHALMIC EXAMINATION
- Approach to diagnosis
- Microbiology studies
- Blood cultures
- Polymerase chain reaction
- SUMMARY AND RECOMMENDATIONS