intro. types. causative agents. clinical features.

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: