Candida retinitis is a fungal infection of the retina, the light-sensitive tissue at the back of the eye. It occurs when Candida fungi infect the eye, potentially causing significant damage. Untreated, it can lead to severe and irreversible vision problems. Recognizing its signs and seeking timely medical care is important.
Understanding Candida Retinitis
Candida retinitis is most frequently caused by Candida albicans, though other Candida species can also be responsible. It usually originates from a systemic bloodstream infection (candidemia), spreading to the eye when fungal cells lodge in retinal blood vessels.
Several factors increase susceptibility to Candida retinitis. A compromised immune system is a risk factor, seen in individuals with HIV/AIDS, those undergoing chemotherapy, or organ transplant recipients on immunosuppressive medications. Prolonged use of broad-spectrum antibiotics can disrupt the body’s natural microbial balance, allowing Candida to overgrow. Intravenous drug use also poses a risk, as it can introduce the fungus directly into the bloodstream.
Central venous catheters, used for long-term medication or nutrition, can serve as entry points for Candida. Patients who have recently undergone major surgeries are also at elevated risk, particularly if they have received multiple courses of antibiotics or have prolonged hospital stays.
Recognizing the Signs
Symptoms of Candida retinitis can vary. Blurred vision is common, often developing gradually as the infection progresses. Floaters (small spots or cobweb-like shapes) are frequent, caused by inflammatory cells and fungal debris in the vitreous humor.
Eye pain or redness can also occur, indicating inflammation. Some individuals may experience photophobia, a sensitivity to light. In advanced cases, the infection can lead to significant vision loss, sometimes progressing rapidly.
Any new or worsening eye symptoms, especially in individuals with risk factors like a weakened immune system or candidemia, warrant immediate medical attention for early diagnosis and intervention.
Diagnosis and Treatment
Diagnosis begins with a comprehensive eye examination by an ophthalmologist. A dilated eye exam using an ophthalmoscope allows detailed visualization of the retina. Characteristic lesions appear as white, fluffy patches with indistinct borders within the retina or vitreous, often accompanied by haze or inflammatory cells.
To confirm candidemia, blood cultures or cultures from other body fluids may be taken. Identifying Candida species helps confirm the fungal infection. In some cases, a vitreous biopsy might be performed for direct fungal culture or molecular testing if diagnosis remains uncertain or infection is severe.
Treatment primarily involves antifungal medications like fluconazole, voriconazole, and amphotericin B. These can be administered intravenously for severe infections or orally for less severe cases or long-term therapy. The choice of agent and route depends on infection severity, Candida species, and patient health.
If there is significant vitreous humor involvement or inadequate response to antifungal therapy, a vitrectomy may be necessary. This surgical procedure removes infected vitreous humor, reducing fungal load and allowing medications to penetrate effectively. Long-term treatment and regular follow-up are required to ensure complete eradication and monitor for recurrence or complications.
Preventing Complications
Untreated or severe Candida retinitis carries a risk of irreversible complications. Permanent vision loss, ranging from partial impairment to complete blindness, is a potential outcome. Ongoing inflammation and retinal damage can lead to structural changes that impair visual function. Retinal detachment, where the retina pulls away from its supporting tissue, is another complication from inflammatory processes or vitreous traction.
Endophthalmitis, a severe inflammation inside the eye, can also occur, leading to widespread destruction of ocular tissues and rapid vision deterioration. Early diagnosis and prompt treatment are important to prevent these outcomes and preserve vision. Delay in antifungal therapy allows the infection to progress, causing more extensive damage and increasing the likelihood of permanent visual impairment.
For individuals at high risk of systemic candidemia, preventive strategies can minimize infection. Maintaining strict hygiene, such as proper handwashing and skin care, can reduce the fungal burden. Careful management of central venous catheters, including regular cleaning and prompt removal, is important to prevent bloodstream infections. Appropriate antibiotic use can help preserve the body’s natural microbial balance, reducing the opportunity for Candida overgrowth.