**26. Endogenous fungal endophthalmitis**

In fungal endophthalmitis, some of the most important metastatic sources of infections in‐ clude endocarditis, gastrointestinal tract, genitourinary tract, skin wound infections, pulmo‐ nary infections, meningitis, and septic arthritis. [102] Other predisposing factors include chronic invasive procedures, such as hemodialysis, bladder catheterization, total parenteral nutrition, chemotherapy, dental procedures, and intravenous drug abuse (Figure 18). In the past, the incidence of endogenous fungal endophthalmitis has been estimated to range be‐ tween 9- 45% of patients with disseminated fungus infection which has decreased in recent years to less than 3%. [1, 102] Candida albicans is by far the most frequent cause (75-80% of fungal cases), followed by Aspergillus species. Because of advanced medical care and a lon‐ ger life-span of patients with chronic diseases in the Western countries along with frequent use of long-term intravenous access, Candida albicans retino-choroiditis has become more common in clinical practice and less common in those with organ transplants and immuno‐ suppression as the result of early ophthalmological screening of all susceptible patients. [81, 99] Endophthalmitis may occur in patients with candidemia depending on the population studied, especially those with an organ transplant and having a highly immunocompro‐ mised status. [1, 3] Aspergillosis is the second most common cause of fungal endophthalmi‐ tis, particularly in intravenous drug abusers. Less frequent causes are other Candida species, Torulopsis glabrata, Cryptococcus neoformans, Sporothrix schenckii, Scedosporium apio‐ spermum (Pseudallescheria boydii), Blastomyces dermatitidis, Coccidioides immitis, and Mucor.

**Figure 18.** Fundus photographs of a 35-years-old immuno-compromised male patient who presented with bilateral decreased vision. He was found to have evidence of bilateral fungal endophthalmitis (a). Initially the patient was treat‐ ed by intra-vitreal antifungal agents (b). Because of worsening of infection, bilateral pars-plana vitrectomy along-with systemic antifungal therapy resulted in clearance o f his eye infection (c). (Photographs: Curtsy of Essam Al-Harthi, MD).
