Candidiasis

  • Systemic infection with Candida fungal organisms
  • Settings are sepsis, chronic parenteral hyperalimentation, hemodialysis, major surgery, burns
  • Retinal infection rare but vision-threatening
  • Patient may report impaired vision if able to communicate
  • Ophthalmoscopy discloses yellow-white mass based in retina but spreading into vitreous cavity
  • Looks like "headlight in fog"
  • Vitreous hemorrhage
  • Posterior uveitis
  • Proliferative diabetic retinopathy
  • Bacterial retinitis or endophthalmitis
  • Other fungal retinitis
  • Ocular trauma
  • Consult ophthalmologist to rule out intraocular spread, especially if patient reports vision impairment or cannot communicate
  • In patients with candida organisms recovered from blood cultures or urine, but no evidence of systemic infection, ophthalmologic examination rarely discloses intraocular infection
  • If ophthalmoscopy discloses findings suggestive of intraocular candida infection, vitreous will be aspirated for smear and culture
  • Intravitreal injection of anti-fungal agent often performed
  • Vitrectomy may also be necessary to preserve vision
  • Visual salvage depends on extent of infection at discovery