Fungal uveitis

Candidiasis

• Candida albicans: yeast-like (reproduces by budding)
• Commensal of skin, mouth

Risk factors

• IVDU (always consider fungal in uveitis in a IV drug user)
• Indwelling catheters
• Immunosuppression

Clinical features

• Reduced vision
• Floaters
• Ocular pain
• Multifocal retinitis: yellow-white fluffy lesions >1DD
• Vitritis: cotton balls forming string of pearls
• Anterior uveitis
• Retinal necrosis
• Tractional RD

Tests

• Vitrectomy for microscopy and culture

Management

• Intravitreal antifungals: amphotericin
• Systemic antifungals: oral fluconazole, IV amphotericin, voriconazole

Aspergillosis

• Generally affects those with chronic pulmonary disease who are immunocompromised
• More aggressive than candid
• Pain
• Rapid vision loss
• Confluent yellowish infiltrate in the subretinal space progressing to subretinal hypopyon
• Intraretinal haemorrhages
• Vitritis
• AC inflammation with hypopyon
• Often requires IV amphotericin

Histoplasmosis and POHS

• Histoplasma capsulatum: dimorphic fungus
• Yeast at 37 degrees, and mycelium in soil
• Direct infection is rare but associated with Presumed Ocular Histoplasmosis Syndrome

Ocular features

• Usually bilateral, sequential disease

• Atrophic choroidal scars around posterior pole (‘histo’ spots)

• Peripapillary atrophy

• Peripheral linear streaks

• Choroidal neovascular membrane

  • FFA can help identify CNV

• Absence of anterior or posterior inflammation

Management

• Antifungals do not help
• Steroids are usually used.