13th February 2025

Fungal causes of uveitis

Rarely, fungal infections can cause endophthalmitis, which involves inflammation of the vitreous or aqueous humour. These may be exogenous, introduced by spread from fungal keratitis or surgeries, or endogenous, for example as a result of intravenous drug use or systemic infection, or immunocompromise. Aspergillus spp. are most commonly implicated in exogenous cases, followed by Candida albicans. The reverse is true for endogenous cases, with Candida spp more prominently associated.

Culture of intraocular fluid is the gold standard for diagnosis. Slit lamp examination may reveal ‘cotton wool’ or ‘fluffy’ chorioretinal infiltrates. The mainstay of treatment is systemic and, if required, intravitreal anti-fungals. Aspergillus spp. endophthalmitis tends to progress more rapidly than candidal infection and is therefore treated more aggressively.