Fungal Endophthalmitis

DOS Times Vol. 12, No. 9 March, 2007 Endophthalmitis is one of the most vision threatening complication in Ophthalmology. Endophthalmitis refers to inflammatory response caused by infected intraocular tissues/ fluids. The frequency of Endophthalmitis after cataract surgery and trauma varies from 0.07 0.13% and 2.417% respectively in the various reported series.1 Majority of these infections are bacterial. Fungal endophthalmitis, despite being rare, is a distinct clinical entity due to delayed diagnosis and poor prognosis associated with it. It could be classified as exogenous or endogenous depending on the clinical setting. Exogenous fungal endophthalmitis could be following trauma or surgery. Conjunctival sac flora appears to be the commonest source of infection in exogenous endophthalmitis. Normal conjunctival flora has 2.9% of fungal isolates comprising of Aspergillus Sp., Rhodotorula, Candida, Penicillium sp. The incidence of fungal isolates further increases in older age, Sjogrens syndrome, prolonged steroid use and in tropical countries. The occurrence of fungal endophthalmitis is rare and is reported to account for 3% of all endophthalmitis in the West.3 However fungal endophthalmitis is not so rare in India. Literature from South India report post surgical and post traumatic fungal endophthalmitis to be 18.6% and 17.7% of the culture positive cases respectively.4,5 The species isolated from India are also different than West where Candida is the commonest isolate. The isolates from India included Aspergillus species in 13.8%, Alternaria in 0.8%, Bipolaris in 0.8%and Helminthosporium in 0.5% in post surgical cases.4 Common isolates in post traumatic fungal endophthalmitis included Acremonium, Aspergillus, Bipolaris, Cladosporium, Fusarium, Dematiaceous fungus, Humicola species.5 Clinical features: Exogenous fungal endophthalmitis is usually seen in healthy immuno-competent adults. Post traumatic fungal endophthalmitis is frequently reported after trauma with vegetative matter. Post surgical fungal endophthalmitis has been reported after cataract extraction, penetrating keratoplasty, glaucoma filteration and scleral buckling. It may sometimes appear as cluster infections caused by the use of contaminated intraocular irrigating solutions, intraocular lenses (IOLs), inadequate ventilation system and hospital construction activity.6-9 Fungal Endophthalmitis