Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Treatment of exogenous endophthalmitis due to Candida species

Carol A Kauffman, MD
Marlene L Durand, MD
Section Editors
Kieren A Marr, MD
Jonathan Trobe, MD
Deputy Editor
Anna R Thorner, MD


Candida species are a common cause of fungal endophthalmitis. This infection arises in two discrete ways:

The exogenous form follows trauma, eye surgery, or progression of fungal keratitis (corneal infection). Fungi are directly inoculated into the aqueous and/or vitreous.

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. (See "Treatment of endogenous endophthalmitis due to Candida species".)

The treatment of exogenous endophthalmitis caused by Candida species will be reviewed here. The epidemiology, pathogenesis, clinical manifestations, and diagnosis of fungal endophthalmitis are discussed separately. The treatment of endogenous endophthalmitis caused by Candida species and endophthalmitis due to molds are also presented separately. Bacterial endophthalmitis and Fusarium keratitis as well as candidemia and other types of Candida infection are also discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of fungal endophthalmitis" and "Treatment of endogenous endophthalmitis due to Candida species" and "Treatment of endophthalmitis due to molds" and "Bacterial endophthalmitis" and "Treatment of candidemia and invasive candidiasis in adults" and "Overview of Candida infections" and "Treatment and prevention of Fusarium infection".)


The term "endophthalmitis" refers to infection within the eye involving the vitreous and/or aqueous (figure 1). Exogenous endophthalmitis signifies that the infection was introduced into the eye from the "outside," either by trauma, eye surgery, or extension of corneal infection (keratitis).


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jan 28, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Barza M. Treatment options for candidal endophthalmitis [editoria; comment]. Clin Infect Dis 1998; 27:1134.
  2. Riddell J 4th, Comer GM, Kauffman CA. Treatment of endogenous fungal endophthalmitis: focus on new antifungal agents. Clin Infect Dis 2011; 52:648.
  3. Durand ML. Endophthalmitis. In: Principles and Practice of Infectious Diseases, 8th edition, Bennett JE, Dolin R, Blaser MJ. (Eds), Elsevier Saunders, Philadelphia 2015. Vol 1, p.1415.
  4. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.
  5. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503.
  6. Pflugfelder SC, Flynn HW Jr, Zwickey TA, et al. Exogenous fungal endophthalmitis. Ophthalmology 1988; 95:19.
  7. Kuriakose T, Kothari M, Paul P, et al. Intracameral amphotericin B injection in the management of deep keratomycosis. Cornea 2002; 21:653.
  8. Yoon KC, Jeong IY, Im SK, et al. Therapeutic effect of intracameral amphotericin B injection in the treatment of fungal keratitis. Cornea 2007; 26:814.
  9. Wykoff CC, Flynn HW Jr, Miller D, et al. Exogenous fungal endophthalmitis: microbiology and clinical outcomes. Ophthalmology 2008; 115:1501.
  10. Shen YC, Wang CY, Tsai HY, Lee HN. Intracameral voriconazole injection in the treatment of fungal endophthalmitis resulting from keratitis. Am J Ophthalmol 2010; 149:916.
  11. Lin RC, Sanduja N, Hariprasad SM. Successful treatment of postoperative fungal endophthalmitis using intravitreal and intracameral voriconazole. J Ocul Pharmacol Ther 2008; 24:245.
  12. Shen YC, Wang MY, Wang CY, et al. Pharmacokinetics of intracameral voriconazole injection. Antimicrob Agents Chemother 2009; 53:2156.
  13. Vemulakonda GA, Hariprasad SM, Mieler WF, et al. Aqueous and vitreous concentrations following topical administration of 1% voriconazole in humans. Arch Ophthalmol 2008; 126:18.
  14. Goyal J, Fernandes M, Shah SG. Intracameral voriconazole injection in the treatment of fungal endophthalmitis resulting from keratitis. Am J Ophthalmol 2010; 150:939; author reply 939.
  15. Kernt M, Neubauer AS, De Kaspar HM, Kampik A. Intravitreal voriconazole: in vitro safety-profile for fungal endophthalmitis. Retina 2009; 29:362.
  16. Kauffman CA, Bradley SF, Vine AK. Candida endophthalmitis associated with intraocular lens implantation: efficacy of fluconazole therapy. Mycoses 1993; 36:13.
  17. Tod M, Lortholary O, Padoin C, Chaine G. Intravenous penetration of fluconazole during endophthalmitis. Clin Microbiol Infect 1997; 3:143.
  18. Urbak SF, Degn T. Fluconazole in the management of fungal ocular infections. Ophthalmologica 1994; 208:147.
  19. Park SS, D'Amico DJ, Paton B, Baker AS. Treatment of exogenous Candida endophthalmitis in rabbits with oral fluconazole. Antimicrob Agents Chemother 1995; 39:958.
  20. Kim JE, Perkins SL, Harris GJ. Voriconazole treatment of fungal scleritis and epibulbar abscess resulting from scleral buckle infection. Arch Ophthalmol 2003; 121:735.
  21. Breit SM, Hariprasad SM, Mieler WF, et al. Management of endogenous fungal endophthalmitis with voriconazole and caspofungin. Am J Ophthalmol 2005; 139:135.
  23. Stern WH, Tamura E, Jacobs RA, et al. Epidemic postsurgical Candida parapsilosis endophthalmitis. Clinical findings and management of 15 consecutive cases. Ophthalmology 1985; 92:1701.