Endophthalmitis

Endophthalmitis is inflammation of the inside of the eye. It can be caused by fungus, when it is called fungal endophthalmitis, or bacteria when it is called bacterial endophthalmitis and allergies if the cause is allergies. This article is about fungal endophthalmitis.

Fungal endophthalmitis

Fungal eye infections are extremely rare, but they can be very serious. The most common way for someone to develop a fungal eye infection is as a result of an eye injury, particularly if the injury was caused by plant material such as a stick or a thorn. Inflammation or infection of the cornea (the clear, front layer of the eye) is known as keratitis, and inflammation or infection in the interior of the eye is called endophthalmitis. Many different types of fungi can cause eye infections.

Symptoms of Fungal Eye Infections

Person using their smartphone. If you have any of these symptoms, call your eye doctor. In people who have had exposures that put them at risk for fungal eye infections, the symptoms of a fungal eye infection can appear anywhere from several days to several weeks after the fungi enter the eye. The symptoms of a fungal eye infection are similar to the symptoms of other types of eye infections (such as those caused by bacteria) and can include:

If you have any of these symptoms, call your eye doctor right away. If you wear contact lenses, remove them immediately. Fungal eye infections are very rare, but if they aren’t treated, they can become serious and result in permanent vision loss or blindness.

Risk factors

Anyone can get a fungal eye infection. These infections usually are linked to one of these situations:

• Eye injury, particularly with plant material (for example, thorns or sticks)
• Eye surgery (such as corneal transplant surgery or cataract surgery)
• Chronic eye disease involving the surface of the eye
• Wearing contact lenses
• Exposure to contaminated medical products that come in contact with the eye
• Fungal bloodstream infection (like candidemia)

Also, people who have diabetes, weakened immune system, or use corticosteroids may be more likely to develop fungal eye infections than other people.

Prevention

If you’re a farm worker or work often with plant materials, wear protective eyewear to help prevent an eye injury.

Causes

Eye Injuries The most common way for someone to get a fungal eye infection is because of an eye injury, particularly if plant material such as a stick or a thorn 1 caused the injury. Some fungi that cause eye infections, such as Fusarium, live in the environment and are often associated with plant material. Fungi can enter the eye and cause infection after an injury.

Eye Surgery Woman having eye surgery Less often, infection can occur after eye surgery such as corneal transplant surgery or cataract surgery.

People who have had surgery to replace their corneas (the clear, front layer of the eye) are at higher risk of fungal eye infections. Each year, about 50,000 Americans have a corneal transplant to replace injured or diseased corneas. A small number of people who have this surgery (about 4 to 7 for every 10,000 transplants) develop a fungal eye infection.

From 2007 to 2014, endophthalmitis, or infection of the interior of the eye, became more than twice as common for people with recent corneal transplant surgery. 2 In the past, this type of endophthalmitis was most commonly caused by bacteria. However, now fungi (most often the Candida species) cause about two-thirds of infections. CDC is working with partners to understand the reasons for this increase in fungal endophthalmitis following corneal transplant surgery and to find ways to prevent it.

Invasive Eye Procedure Fungal eye infections could happen after an invasive eye procedure such as an injection. Some infections have been traced to contaminated medical products such as contact lens solution, 3 irrigation solution 4 and dye 5 used during eye surgery, or corticosteroids injected directly into the eye.

Fungal Bloodstream Infection Rarely, fungal eye infections can happen after a fungal bloodstream infection such as candidemia spreads to the eye.

Diagnosis and Testing

To diagnose a fungal eye infection, your eye doctor will examine your eye and might take a small sample of tissue or fluid from your eye. The sample will be sent to a laboratory to be examined under a microscope or cultured. Polymerase chain reaction (PCR) and confocal microscopy are also being used as newer, faster forms of diagnosis; however, culture is the standard method for the definitive diagnosis of a fungal eye infection.

Treatment for Fungal Eye Infections

The treatment for a fungal eye infection depends on:

• The type of fungus,
• The severity of the infection, and
• The parts of the eye that are affected.

Possible forms of treatment for fungal eye infections include:

• Antifungal eye drops
• Antifungal medication given as a pill or through a vein
• Antifungal medication injected directly into the eye
• Eye surgery

All types of fungal eye infections must be treated with prescription antifungal medication, usually for several weeks to months. Natamycin is a topical (meaning it’s given in the form of eye drops) antifungal medication that works well for fungal infections involving the outer layer of the eye, particularly those caused by fungi such as Aspergillus and Fusarium. However, infections that are deeper and more severe may require treatment with antifungal medication such as amphotericin B, fluconazole, or voriconazole. These medications can be given by mouth, through a vein, or injected directly into the eye. Patients whose infections don’t get better after using antifungal medications may need surgery, including corneal transplantation, removal of vitreous gel from the interior of the eye (vitrectomy), or, in extreme cases, removal of the eye (enucleation).

Fungal Eye Infection Statistics

Fungal keratitis: The exact incidence of fungal keratitis in the general population is unknown, but it’s thought to be more common in warmer climates where the fungi that cause these infections are likely more common in the environment.

Exogenous fungal endophthalmitis (fungi enter the eye from outside the body): Endophthalmitis is a very rare complication of eye injury or eye surgery; in the United States, it occurs as a post-surgical complication in approximately 0.1% of all cataract surgeries Furthermore, only a small percentage of these infections are caused by fungi; bacterial endophthalmitis is more common.

Endogenous fungal endophthalmitis (fungi enter the eye as a result of an existing bloodstream infection): Endogenous endophthalmitis is extremely rare and is less common than exogenous endophthalmitis; studies have estimated that only 2 to 15% of all endophthalmitis cases are endogenous. Candida species are the most common cause of endogenous fungal endophthalmitis. An estimated 1% of patients with candidemia develop Candida endophthalmitis.

Endophthalmitis Resources
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