Diagnosis and management of Candida endophthalmitis and chorioretinitis.

Background: Candida endophthalmitis (CE) and chorioretinitis are uncommon but potentially devastating complications of candidemia, associated with significant risks of vision loss and long-term morbidity. Effective management relies on timely diagnosis and targeted antifungal therapy. However, diagnostic and therapeutic approaches are hindered by inconsistent guidelines, limited evidence, and variations in clinical practice.

Objectives: This review synthesizes current knowledge on CE and chorioretinitis to provide a comprehensive framework for clinicians. It addresses diagnostic challenges, including ophthalmoscopy, imaging, and microbiological diagnostics, and therapeutic strategies such as systemic and intravitreal antifungal therapies, surgical interventions, and serial ophthalmic evaluations.

Sources: An extensive literature search was conducted using PubMed, Embase, and Scopus, with a focus on epidemiology, pathogenesis, diagnostics, treatment, and outcomes. Guidelines from the Infectious Diseases Society of America, European Confederation for Medical Mycology, and American Academy of Ophthalmology were reviewed.

Content: The prevalence of CE among patients with candidemia has increased from 1.8% in the pre-echinocandin era to 2.1% after the introduction of echinocandins. Diagnosis relies primarily on indirect ophthalmoscopy, the reference standard for retinal visualization. In selected cases, optical coherence tomography or fundus photography may support lesion assessment. Microbiological confirmation via vitreous sampling remains definitive but is often limited by low organism burden. Emerging diagnostics-such as clustered regularly interspaced short palindromic repeats-based fungal DNA assays-have shown promise. Although artificial intelligence-assisted imaging tools are established in other retinal diseases, they have not yet been validated for Candida ocular infections. Fluconazole and voriconazole remain first-line systemic therapies, with intravitreal injections and vitrectomy reserved for severe cases.

Implications: Improving outcomes in CE requires harmonized screening protocols, timely access to ophthalmologic care, and multidisciplinary collaboration. Future research should aim to refine diagnostic algorithms, define optimal treatment durations, clarify the role of emerging diagnostics, and leverage telemedicine and imaging technologies to improve early detection and longitudinal monitoring.