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Candida Endophthalmitis — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsCandida EndophthalmitisSCE Infectious Diseases

A 60-year-old man on the ICU with invasive Candida infection undergoes ophthalmological assessment as part of routine candidaemia workup. Dilated fundoscopy reveals white fluffy retinal lesions extending into the vitreous (vitritis). What is the diagnosis and how does it affect treatment duration?

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Correct answer: A — Candida endophthalmitis — treatment duration must be extended to at least 4–6 weeks with agents achieving adequate vitreous concentrations (Fluconazole or Voriconazole); intravitreal antifungal injection may be needed

Candida endophthalmitis (chorioretinitis ± vitritis) complicates approximately 5–15% of candidaemia cases. All patients with candidaemia should have dilated fundoscopy within 1 week of diagnosis. The finding of endophthalmitis significantly alters management: treatment duration is extended to 4–6 weeks minimum, the antifungal must achieve adequate vitreous penetration (Fluconazole or Voriconazole — echinocandins have poor vitreous penetration), and intravitreal injection (Amphotericin B 5–10 µg or Voriconazole 100 µg) may be needed for vitritis. Ophthalmology co-management is essential.

Reference: ESCMID 2024 – Candida guidelines; IDSA 2016 – Candidiasis; RCOphth 2023