Candida Endophthalmitis Complicating Candidemia

Seven patients with endophthalmitis secondary to Candida species had complicated medical or surgical problems. Six patients had been given multiple antibiotics, and two received corticosteroids. Candidemia was demonstrable in five patients; in three, extraocular sites of candida infection were noted. Redness and irritation of the eye, which suggested simple conjunctivitis to the internist, appeared 3 to 35 days after detection of candidemia. Ophthalmological examination showed marked iritis in six patients; chorioretinal involvement in two; vitreous abscesses in four; and an iris abscess in one patient. Pathological examination of the eyes in four patients showed yeast or pseudohyphal forms in all specimens. Three patients were treated with antifungal agents; two responded favorably to amphotericin B, and one did not respond to 5-fluorocytosine. After fungemia is detected, an eye examination should be carried out and, when ocular lesions are noted, vigorous antifungal therapy instituted.