Guidelines Summary

The Infectious Diseases Society of America, in contrast with the American Academy of Ophthalmology, advocates routine ophthalmologic screening of all patients who have laboratory findings of systemic Candida septicemia.^{[33, 34]} The American Academy of Ophthalmology considers such screening a low value practice and instead recommends screening for patients with signs and symptoms suggestive of ocular infection regardless of Candida septicemia.^[34] Recent findings from the Wilmer Eye Institute and the Bascom Palmer Eye Institute validate the American Academy of Ophthalmology's recommendations. Both institutions reported no patient identified with fungal endophthalmitis through routine screening.^{[14, 35]}

Medication

Essman TF, Flynn HW Jr, Smiddy WE, Brod RD, Murray TG, Davis JL. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers. 1997 Mar. 28(3):185-94. [QxMD MEDLINE Link].
Klotz SA, Penn CC, Negvesky GJ, Butrus SI. Fungal and parasitic infections of the eye. Clin Microbiol Rev. 2000 Oct. 13(4):662-85. [QxMD MEDLINE Link].
Sridhar J, Flynn HW Jr, Kuriyan AE, Miller D, Albini T. Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections. J Ophthalmic Inflamm Infect. 2013. 3(1):60. [QxMD MEDLINE Link].
Sridhar J, Flynn HW Jr, Kuriyan AE, Miller D, Albini T. Endogenous fungal endophthalmitis: risk factors, clinical features, and treatment outcomes in mold and yeast infections. J Ophthalmic Inflamm Infect. 2013 Sep 20. 3 (1):60. [QxMD MEDLINE Link].
Smith TC, Benefield RJ, Kim JH. Risk of Fungal Endophthalmitis Associated with Cataract Surgery: A Mini-Review. Mycopathologia. 2015 Dec. 180 (5-6):291-7. [QxMD MEDLINE Link].
Mikosz CA, Smith RM, Kim M, Tyson C, Lee EH, Adams E. Fungal endophthalmitis associated with compounded products. Emerg Infect Dis. 2014 Feb. 20(2):248-56. [QxMD MEDLINE Link].
Schiedler V, Scott IU, Flynn HW, Davis JL, Benz MS, Miller D. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol. 2004 Apr. 137(4):725-31. [QxMD MEDLINE Link].
Shah CP, McKey J, Spirn MJ, Maguire J. Ocular candidiasis: a review. Br J Ophthalmol. 2008 Apr. 92(4):466-8. [QxMD MEDLINE Link].
Rao NA, Hidayat A. A comparative clinicopathologic study of endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared to aspergillosis. Trans Am Ophthalmol Soc. 2000. 98:183-93; discussion 193-4. [QxMD MEDLINE Link].
Lundquist O, Osterlin S. Glucose concentration in the vitreous of nondiabetic and diabetic human eyes. Graefes Arch Clin Exp Ophthalmol. 1994 Feb. 232(2):71-4. [QxMD MEDLINE Link].
Paulus YM, Cheng S, Karth PA, Leng T. PROSPECTIVE TRIAL OF ENDOGENOUS FUNGAL ENDOPHTHALMITIS AND CHORIORETINITIS RATES, CLINICAL COURSE, AND OUTCOMES IN PATIENTS WITH FUNGEMIA. Retina. 2015 Dec 11. [QxMD MEDLINE Link].
Lalwani GA, Flynn HW Jr, Scott IU, Quinn CM, Berrocal AM, Davis JL, et al. Acute-onset endophthalmitis after clear corneal cataract surgery (1996-2005). Clinical features, causative organisms, and visual acuity outcomes. Ophthalmology. 2008 Mar. 115(3):473-6. [QxMD MEDLINE Link].
Anand A, Madhavan H, Neelam V, Lily T. Use of polymerase chain reaction in the diagnosis of fungal endophthalmitis. Ophthalmology. 2001 Feb. 108(2):326-30. [QxMD MEDLINE Link].
Priluck AZ, Huang P, Breazzano MP. Outcomes and Clinical Features Predictive of Fungal Endophthalmitis. Am J Ophthalmol. 2023 Feb 21. [QxMD MEDLINE Link].
Sallam A, Taylor SR, Khan A, McCluskey P, Lynn WA, Manku K. FACTORS DETERMINING VISUAL OUTCOME IN ENDOGENOUS CANDIDA ENDOPHTHALMITIS. Retina. 2012 Jan 31. [QxMD MEDLINE Link].
Tanaka H, Ishida K, Yamada W, Nishida T, Mochizuki K, Kawakami H. Study of ocular candidiasis during nine-year period. J Infect Chemother. 2016 Mar. 22 (3):149-56. [QxMD MEDLINE Link].
Duan F, Yang Y, Yuan Z, Zheng Y, Cheng Z, Lin X. Clinical Features and Visual Acuity Outcomes in Culture-Positive Endogenous Fungal Endophthalmitis in Southern China. J Ophthalmol. 2017. 2017:3483497. [QxMD MEDLINE Link].
Zaslavsky K, Grewal PS, Cruz-Pimentel M, Qian J, Derzko-Dzulynsky L, Yan P. ENDOGENOUS FUNGAL ENDOPHTHALMITIS FOLLOWING COVID-19 INFECTION: CASE REPORT AND REVIEW OF LITERATURE. Retin Cases Brief Rep. 2022 Jul 29. [QxMD MEDLINE Link].
Agarwal M, Sachdeva M, Pal S, Shah H, Kumar R M, Banker A. Endogenous Endophthalmitis A Complication of COVID-19 Pandemic: A Case Series. Ocul Immunol Inflamm. 2021 May 19. 29 (4):726-729. [QxMD MEDLINE Link].
Shroff D, Narula R, Atri N, Chakravarti A, Gandhi A, Sapra N, et al. Endogenous fungal endophthalmitis following intensive corticosteroid therapy in severe COVID-19 disease. Indian J Ophthalmol. 2021 Jul. 69 (7):1909-1914. [QxMD MEDLINE Link].
Kato H, Yoshimura Y, Suido Y, Ide K, Sugiyama Y, Matsuno K, et al. Prevalence of, and risk factors for, hematogenous fungal endophthalmitis in patients with Candida bloodstream infection. Infection. 2018 Jun 29. [QxMD MEDLINE Link].
Lei B, Jiang R, Gu R, Xu G, Song F, Zhou M. Endogenous Fungal Endophthalmitis Associated with Genitourinary Procedures. Ocul Immunol Inflamm. 2018 Jul 11. 1-9. [QxMD MEDLINE Link].
Sakai T, Kohzaki K, Watanabe A, Tsuneoka H, Shimadzu M. Use of DNA microarray analysis in diagnosis of bacterial and fungal endophthalmitis. Clin Ophthalmol. 2012. 6:321-6. [QxMD MEDLINE Link].
Tanaka M, Kobayashi Y, Takebayashi H, Kiyokawa M, Qiu H. Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12-year study of 79 eyes of 46 patients. Retina. 2001. 21 (3):203-9. [QxMD MEDLINE Link].
Sakai D, Matsumiya W, Kusuhara S, Nakamura M. Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia. J Ophthalmic Inflamm Infect. 2021 Jun 14. 11 (1):17. [QxMD MEDLINE Link].
Chen L, Tao Y, Hu X. Utility of Intraocular Fluid β-D-glucan Testing in Fungal Endophthalmitis: A Series of 5 Cases. Am J Case Rep. 2020 Mar 23. 21:e921188. [QxMD MEDLINE Link].
William A, Spitzer MS, Deuter C, Blumenstock G, Partsch M, Voykov B, et al. Outcomes of Primary Transconjunctival 23-Gauge Vitrectomy in the Diagnosis and Treatment of Presumed Endogenous Fungal Endophthalmitis. Ocul Immunol Inflamm. 2016 Jan 30. 1-7. [QxMD MEDLINE Link].
Khan FA, Slain D, Khakoo RA. Candida endophthalmitis: focus on current and future antifungal treatment options. Pharmacotherapy. 2007 Dec. 27(12):1711-21. [QxMD MEDLINE Link].
Mora-Duarte J, Betts R, Rotstein C, Colombo AL, Thompson-Moya L, Smietana J. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002 Dec 19. 347(25):2020-9. [QxMD MEDLINE Link].
Gauthier GM, Nork TM, Prince R, Andes D. Subtherapeutic ocular penetration of caspofungin and associated treatment failure in Candida albicans endophthalmitis. Clin Infect Dis. 2005 Aug 1. 41(3):e27-8. [QxMD MEDLINE Link].
Stephens JD, Adam MK, Todorich B, Faia LJ, Garg S, Dunn JP, et al. Optical Coherence Tomography Findings in Endogenous Fungal Chorioretinitis, Retinitis, and Endophthalmitis. Ophthalmic Surg Lasers Imaging Retina. 2017 Nov 1. 48 (11):894-901. [QxMD MEDLINE Link].
Mikosz CA, Smith RM, Kim M, Tyson C, Lee EH, Adams E, et al. Fungal endophthalmitis associated with compounded products. Emerg Infect Dis. 2014 Feb. 20 (2):248-56. [QxMD MEDLINE Link].
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15. 62 (4):409-17. [QxMD MEDLINE Link].
Breazzano MP, Bond JB 3rd, Bearelly S, Kim DH, Donahue SP, Lum F, et al. American Academy of Ophthalmology Recommendations on Screening for Endogenous Candida Endophthalmitis. Ophthalmology. 2022 Jan. 129 (1):73-76. [QxMD MEDLINE Link].
Lingappan A, Wykoff CC, Albini TA, Miller D, Pathengay A, Davis JL, et al. Endogenous fungal endophthalmitis: causative organisms, management strategies, and visual acuity outcomes. Am J Ophthalmol. 2012 Jan. 153 (1):162-6.e1. [QxMD MEDLINE Link].
Akler ME, Vellend H, McNeely DM, Walmsley SL, Gold WL. Use of fluconazole in the treatment of candidal endophthalmitis. Clin Infect Dis. 1995 Mar. 20(3):657-64. [QxMD MEDLINE Link].
Blumenkranz MS, Stevens DA. Therapy of endogenous fungal endophthalmitis: miconazole or amphotericin B for coccidioidal and candidal infection. Arch Ophthalmol. 1980 Jul. 98(7):1216-20. [QxMD MEDLINE Link].
Breit SM, Hariprasad SM, Mieler WF et al. Management of endogenous fungal endophthalmitis with voriconazole and caspofungin. Am J Ophthalmol. 2005 Jan. 139(1):135-40. [QxMD MEDLINE Link].
Brod RD, Flynn HW, Clarkson JG, Pflugfelder SC, Culbertson WW, Miller D. Endogenous Candida endophthalmitis. Management without intravenous amphotericin B. Ophthalmology. 1990 May. 97(5):666-72; disc: 672-4. [QxMD MEDLINE Link].
Brooks RG. Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch Intern Med. 1989 Oct. 149(10):2226-8. [QxMD MEDLINE Link].
Christmas NJ, Smiddy WE. Vitrectomy and systemic fluconazole for treatment of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers. 1996 Dec. 27(12):1012-8. [QxMD MEDLINE Link].
Cornely OA, Schmitz K, Aisenbrey S. The first echinocandin: caspofungin. Mycoses. 2002. 45 Suppl 3:56-60. [QxMD MEDLINE Link].
Crump JR, Elner SG, Elner VM, Kauffman CA. Cryptococcal endophthalmitis: case report and review. Clin Infect Dis. 1992 May. 14(5):1069-73. [QxMD MEDLINE Link].
Donahue SP, Greven CM, Zuravleff JJ, Eller AW, Nguyen MH, Peacock JE Jr, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology. 1994 Jul. 101(7):1302-9. [QxMD MEDLINE Link].
Edwards JE Jr, Foos RY, Montgomerie JZ, Guze LB. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis. Medicine (Baltimore). 1974 Jan. 53(1):47-75. [QxMD MEDLINE Link].
Gao H, Pennesi ME, Shah K, Qiao X, Hariprasad SM, Mieler WF, et al. Intravitreal voriconazole: an electroretinographic and histopathologic study. Arch Ophthalmol. 2004 Nov. 122(11):1687-92. [QxMD MEDLINE Link].
Griffin JR, Pettit TH, Fishman LS, Foos RY. Blood-borne Candida endophthalmitis. A clinical and pathologic study of 21 cases. Arch Ophthalmol. 1973 Jun. 89(6):450-6. [QxMD MEDLINE Link].
Gross JG. Endogenous Aspergillus-induced endophthalmitis. Successful treatment without systemic antifungal medication. Retina. 1992. 12(4):341-5. [QxMD MEDLINE Link].
Henderson DK, Edwards JE Jr, Montgomerie JZ. Hematogenous candida endophthalmitis in patients receiving parenteral hyperalimentation fluids. J Infect Dis. 1981 May. 143(5):655-61. [QxMD MEDLINE Link].
Hunt KE, Glasgow BJ. Aspergillus endophthalmitis. An unrecognized endemic disease in orthotopic liver transplantation. Ophthalmology. 1996 May. 103(5):757-67. [QxMD MEDLINE Link].
Luttrull JK, Wan WL, Kubak BM, Smith MD, Oster HA. Treatment of ocular fungal infections with oral fluconazole. Am J Ophthalmol. 1995 Apr. 119(4):477-81. [QxMD MEDLINE Link].
Martinez-Vazquez C, Fernandez-Ulloa J, Bordón J, Sopena B, de la Fuente J, Ocampo A, et al. Candida albicans endophthalmitis in brown heroin addicts: response to early vitrectomy preceded and followed by antifungal therapy. Clin Infect Dis. 1998 Nov. 27(5):1130-3. [QxMD MEDLINE Link].
McDonald HR, De Bustros S, Sipperley JO. Vitrectomy for epiretinal membrane with Candida chorioretinitis. Ophthalmology. 1990 Apr. 97(4):466-9. [QxMD MEDLINE Link].
Naoi N, Sawada A. Effect of vitrectomy on epiretinal membranes after endogenous fungal endophthalmitis. Jpn J Ophthalmol. 1996. 40(3):434-8. [QxMD MEDLINE Link].
Okhravi N, Adamson P, Mant R, Matheson MM, Midgley G, Towler HM, et al. Polymerase chain reaction and restriction fragment length polymorphism mediated detection and speciation of Candida spp causing intraocular infection. Invest Ophthalmol Vis Sci. 1998 May. 39(6):859-66. [QxMD MEDLINE Link].
Okhravi N, Dart JK, Towler HM, Lightman S. Paecilomyces lilacinus endophthalmitis with secondary keratitis: a case report and literature review. Arch Ophthalmol. 1997 Oct. 115(10):1320-4. [QxMD MEDLINE Link].
Ozdamar A, Aras C, Ozturk R, Akin E, Karacorlu M, Ercikan C. In vitro antimicrobial activity of silicone oil against endophthalmitis-causing agents. Retina. 1999. 19(2):122-6. [QxMD MEDLINE Link].
Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmology. 1982 Jul. 89(7):789-96. [QxMD MEDLINE Link].
Scherer WJ, Lee K. Implications of early systemic therapy on the incidence of endogenous fungal endophthalmitis. Ophthalmology. 1997 Oct. 104(10):1593-8. [QxMD MEDLINE Link].
Sheu SJ, Chen YC, Kuo NW, et al. Endogenous cryptococcal endophthalmitis. Ophthalmology. 1998 Feb. 105(2):377-81. [QxMD MEDLINE Link].
Smiddy WE. Treatment outcomes of endogenous fungal endophthalmitis. Curr Opin Ophthalmol. 1998 Jun. 9(3):66-70. [QxMD MEDLINE Link].
Smith SR, Kroll AJ, Lou PL, Ryan EA. Endogenous bacterial and fungal endophthalmitis. Int Ophthalmol Clin. 2007. 47(2):173-83. [QxMD MEDLINE Link].
Weishaar PD, Flynn HW, Murray TG, Davis JL, Barr CC, Gross JG, et al. Endogenous Aspergillus endophthalmitis: clinical features and treatment outcomes. Ophthalmology. 1998 Jan. 105(1):57-65. [QxMD MEDLINE Link].
Weissgold DJ, Maguire AM, Brucker AJ. Management of postoperative acremonium endophthalmitis. Ophthalmology. 1996 May. 103(5):749-56. [QxMD MEDLINE Link].
Zakka KA, Foos RY, Brown WJ. Intraocular coccidioidomycosis. Surv Ophthalmol. 1978 Mar-Apr. 22(5):313-21. [QxMD MEDLINE Link].
Zhang YQ, Wang WJ. Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina. 2005 Sep. 25(6):746-50. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Lihteh Wu, MD Ophthalmologist, Costa Rica Vitreo and Retina Macular Associates

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Club Jules Gonin, Macula Society, Pan-American Association of Ophthalmology, Retina Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Bayer; Quantel Medical, Roche; Iveric Bio<br/>Received income in an amount equal to or greater than $250 from: Bayer Health; Quantel Medical, Roche, Iveric Bio.

Coauthor(s)

Dhariana Acón, MD Ophthalmologist, Caja Costarricense Seguro Social, Hospital de Guapiles, Costa Rica

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

R Christopher Walton, MD Adjunct Professor, Department of Ophthalmology, University of Texas Health Science Center at San Antonio

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.