Ophthalmologic Complications of Cryptococcal Meningitis

Cryptococcosis, a systemic fungal disease caused byCryptococcus neoformansoften becomes perceptible to the patient only after localization in the central nervous system.1Headache is the most common initial complaint, but is usually associated with other symptoms, including mental and visual changes, nausea and vomiting, neck pain, feverishness, and weakness.2Sometimes such symptoms are a reflection of elevated cerebrospinal fluid pressure, and this is especially true for the ophthalmologic complaints. The ocular complications which have been reported include photophobia, diplopia, ptosis, amblyopia, nystagmus, ophthalmoplegia, anisocoria, papilledema, neuroretinitis, and primary optic atrophy.3In rare instances, clinically apparent cryptococcal infection may be localized to the eye3,12; however, most frequently eye involvement is either the result of direct extension to the optic nerve via the subarachnoidal space, or associated with widespread disseminated disease.1 Untreated, cryptococcal meningitis is almost always a fatal disease, sometimes with a prolonged course.4