FUNGALENDOPHTHALMATITS

Kamal thakur

2nd year bsc opto

FUNGAL ENDOPHTHALMATITS

It is suppurative inflammation of inner ocular

coats and their adjacent structure, with

involvement of anterior chamber and vitreous

fluid.

It is caused by various fungal agents

FUNGAL ENDOPHTHALMITIS

Clinically two types

Endogenous due to hematogenous spread

Exogenous due to trauma or post operative

ENDOGENOUS ENDOPHTHALMITIS

The first description of endogenous fungal

endophthalmitis was by Dimmer in 1913.

ENDOGENOUS ENDOPHTHALMITIS

Predisposing factors

Malignancy

IVDU (intravenous drug use)

Chemotherapy

Systemic antibiotics

Alcoholism & Diabetes

CAUSATIVE AGENTS OF ENDOGENOUS

ENDOPHTHALMITIS

Candida albicans

Fusarium species

Aspergillus species

Histoplasma capsulatum

Coccidioides immitis

Blastomyces dermatitidis

Cryptococcus neoformnas

CANDIDA ALBICANS

Infection usually starts from Choroid and then

spreads to retina

Candida endogenous fungal

endophthalmitis manifesting

as multiple chorioretinal

lesions..

ASPERGILLUS ENDOPHTHALMITIS

Spreads from lungs to eye

Aspergillus

endophthalmitis

(infection of the

retina of the eye),

following

dissemination from

the lung.

CRYPTOCOCCAL ENDOPTHALMITIS

From lung,

disseminated haematogenesouly and can affect CNS

causing fungal meningitis & endophthalmitis in eye.

Choroids is the probably first site of ocular infections

CAUSATIVE AGENT OF EXOGENOUS

ENDOPHTHALMITIS

Aspergillus spp.

C. albicans,C. glabrata, C. tropicalis, C.

parapsilosis

Fusarium spp.

Acremonium spp.

Curvularia spp.

PATHOGENESIS: EXOGENOUS

Direct introduction of the organisms following

Surgery(Catarct removal with placement of IOL

mainly Candida spp)

Trauma(Mainly Fusarium spp. )

spread from Fungal keratitis

CLINICAL FEATURES

Symptoms

Visual loss

Red eye.

Photophobia.

Pain.

Floaters.

Scotoma

LABORATORY DIAGNOSIS

Sample collection and transport

AC tap

Vitreous tap Fluids

CONVENTIONAL TECHNIQUES Direct microscopy Rapid and cost effective

10% KOH preparation .

Gram stain .

Calcoflour Stain – Easy and fast.

Culture SDA, Blood agar.

Susceptibility testing

CULTURE

Vitreous fluid inoculated on routine fungal culture media .

Vitreous sample should be concentrate either by

centrifugation Millipore filtration

All the culture checked everyday during first week and

twice a week during next 3 weeks.

Positive culture are more convincing when growth is

obtained on more than one occasion.

ENDOGENOUS ENDOPHTHALMITIS

Systemic antifungal agents:

Fluconazole,

voriconazole (azole compounds)

Systemic antifungal agents:

Amphotericin B: Parenteral ± intravitreal

EXOGENOUS ENDOPHTHALMITIS

Intraocular (intracameral ± intravitreal) amphotericin B

Intravitreal voriconazole or miconazole

Subconjunctival antifungal agents: when associated with

keratitis

Systemic antifungal agents: fluconazole, ketoconazole,

voriconazole, itraconazole, miconazole, and amphotericin

B: