Fungal endophthalmitis is an inflammation of the inner eye that can be either endogenous or exogenous in origin. Endogenous fungal endophthalmitis spreads hematogenously from sites like the lungs or CNS and is caused by fungi such as Candida, Aspergillus, and Cryptococcus. Exogenous fungal endophthalmitis results from trauma, surgery, or spread from fungal keratitis and is commonly caused by Aspergillus, Candida, and Fusarium. Diagnosis involves microscopy, culture, and susceptibility testing of fluid samples from the anterior chamber or vitreous humor. Treatment consists of systemic and intraocular antifungal drugs depending on whether the infection is endogenous

1. FUNGAL
ENDOPHTHALMATITS
Kamal thakur
2nd year bsc opto

2. 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

4. FUNGAL ENDOPHTHALMITIS
 Clinically two types
 Endogenous due to hematogenous spread
 Exogenous due to trauma or post operative

5. ENDOGENOUS ENDOPHTHALMITIS
 The first description of endogenous fungal
endophthalmitis was by Dimmer in 1913.

6. ENDOGENOUS ENDOPHTHALMITIS
 Predisposing factors
 Malignancy
 IVDU (intravenous drug use)
 Chemotherapy
 Systemic antibiotics
 Alcoholism & Diabetes

7. CAUSATIVE AGENTS OF ENDOGENOUS
ENDOPHTHALMITIS
 Candida albicans
 Fusarium species
 Aspergillus species
 Histoplasma capsulatum
 Coccidioides immitis
 Blastomyces dermatitidis
 Cryptococcus neoformnas

8. CANDIDA ALBICANS
 Infection usually starts from Choroid and then
spreads to retina
Candida endogenous fungal
endophthalmitis manifesting
as multiple chorioretinal
lesions..

9. ASPERGILLUS ENDOPHTHALMITIS
 Spreads from lungs to eye
Aspergillus
endophthalmitis
(infection of the
retina of the eye),
following
dissemination from
the lung.

10. 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

11. CAUSATIVE AGENT OF EXOGENOUS
ENDOPHTHALMITIS
 Aspergillus spp.
 C. albicans,C. glabrata, C. tropicalis, C.
parapsilosis
 Fusarium spp.
 Acremonium spp.
 Curvularia spp.

12. 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

13. CLINICAL FEATURES
 Symptoms
Visual loss
Red eye.
Photophobia.
Pain.
Floaters.
Scotoma

14. LABORATORY DIAGNOSIS
 Sample collection and transport
 AC tap
 Vitreous tap Fluids

15. CONVENTIONAL TECHNIQUES
 Direct microscopy Rapid and cost effective
 10% KOH preparation .
 Gram stain .
 Calcoflour Stain – Easy and fast.
 Culture SDA, Blood agar.
Susceptibility testing

16. 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.

17. ENDOGENOUS ENDOPHTHALMITIS
Systemic antifungal agents:
 Fluconazole,
 voriconazole (azole compounds)
 Systemic antifungal agents:
 Amphotericin B: Parenteral ± intravitreal

18. 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: