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Figure 1. Stage I: Candida chorioretinits with a creamy parafoveal chorioretinal lesion.
(Figure omitted. See article PDF.)
Figure 2. Stage II: Candida chorioretinitis with multiple creamy nummular lesions. Note the fungal mass budding into the vitreous cavity without significant vitritis.
(Figure omitted. See article PDF.)
Figure 3. Stage III: Candida endophthalmitis with typical 'string-of-pearls' appearance of vitreal fluff balls.
(Figure omitted. See article PDF.)
Candida species are ubiquitous organisms and are frequently found as a constituent in the human urogenital, respiratory and gastrointestinal flora. They account for the majority of human fungal infections [1] and are the causative organism in approximately 20% of cases presenting with fungal endophthalmitis [2]. Ocular candidiasis can arise from hematogenous seeding, leading to the endogenous form of the infection. The choroidal vessels are the usual portal, although, uncommonly, the retinal circulation can be the vehicle. In many cases, patients presenting with endogenous ocular candidiasis have a systemic fungal infection and are often immunocompromised [3]. Those patients apparently without systemic symptoms should have a careful social history taken, as well as a thorough physical examination by an internist. Exogenous ocular candidiasis refers to the introduction of Candida species into the eye through ophthalmic surgery, penetrating ocular trauma or spread from a local focus, such as a fungal keratitis.
There are two distinct clinical patterns of ocular candidiasis, chorioretinitis and endophthalmitis. In practice, these patterns can represent differences in location of involvement or severity. Chorioretinitis is typically defined as focal involvement, with deep, white, infiltrative chorioretinal lesions but without evidence of vitreal involvement (Figure 1) [3]. Candida endophthalmitis, by contrast, has more extensive ocular involvement with seeding of the vitreous (Figure 2), giving rise to the clinical findings of 'intravitreal fluff balls' [4] or a 'string of pearls' (Figure 3). Vitreous seeding can occur, however, without significant vitritis.
This paper reviews the epidemiology, diagnosis and management options for patients with ocular candidiasis. Because of the rarity of this condition, most recommendations are based on small patient series, case reports and expert opinions.
Epidemiology
Candida: microbiologic spectrum
A variety of Candida species are capable of causing infections in humans but most series have shown Candida albicans to be the most common pathogen [3-6]. Furthermore, C. albicans confers a greater risk of...