Treatment of endogenous endophthalmitis due to Candida species
- 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
- Marlene L Durand, MD
Marlene L Durand, MD
- Associate Professor of Medicine
- Harvard Medical School
- 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
Candida species are a common cause of fungal endophthalmitis. This infection arises in two distinct ways:
●The endogenous form follows candidemia, with hematogenous seeding of the eye. Fungi usually first seed the highly vascular choroid, then infection typically progresses through the retina into the vitreous. The aqueous is sometimes involved as well.
●The exogenous form follows trauma, eye surgery, or progression of fungal keratitis (corneal infection). Fungi are directly inoculated into the aqueous and/or vitreous. (See "Treatment of exogenous endophthalmitis due to Candida species".)
The management of endogenous endophthalmitis due to Candida species will be reviewed here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of fungal endophthalmitis are discussed separately. The management of exogenous endophthalmitis due to Candida species and endophthalmitis due to molds are also presented elsewhere. Bacterial endophthalmitis, Fusarium keratitis, and candidemia and other types of Candida infection are also discussed elsewhere. (See "Epidemiology, clinical manifestations, and diagnosis of fungal endophthalmitis" and "Treatment of exogenous endophthalmitis due to Candida species" and "Treatment of endophthalmitis due to molds" and "Bacterial endophthalmitis" and "Treatment and prevention of Fusarium infection", section on 'Keratitis' and "Treatment of candidemia and invasive candidiasis in adults" and "Overview of Candida infections".)
The terminology of Candida endophthalmitis may be confusing. The term "endophthalmitis" means infection within the eye and in general implies infection of the vitreous and/or aqueous (figure 1). Endogenous Candida endophthalmitis often presents first as chorioretinitis with minimal vitritis (vitreous inflammation) then later progresses to produce vitreous and sometimes aqueous infection. The term "ocular candidiasis" is used to describe this spectrum of infection, and some articles in the literature reserve the term "Candida endophthalmitis" only for cases in which the vitreous and/or aqueous are involved. However, the majority of publications include the entire spectrum, including chorioretinitis, in the term "Candida endophthalmitis," so we will follow this convention. We will note the distinction between chorioretinitis alone and Candida infection that extends to involve the vitreous throughout this topic because the approach to therapy differs between these two conditions.
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- Approach to treatment
- - Endogenous endophthalmitis without vitritis
- - Endogenous endophthalmitis with vitritis
- - Duration of systemic therapy
- Systemic antifungal therapy
- - Amphotericin B and flucytosine
- - Fluconazole
- - Voriconazole
- - Posaconazole
- - Echinocandins
- Intravitreal antifungal agents and vitrectomy
- SUMMARY AND RECOMMENDATIONS
- Endogenous endophthalmitis without vitritis
- Endogenous endophthalmitis with vitritis
- Exogenous endophthalmitis