👁️ Other forms of Aspergillosis: Aspergillus Endophthalmitis, A Rare Eye Infection

🧐 What Is It?

Aspergillus endophthalmitis is a severe fungal infection that affects the inside of the eye — specifically the vitreous (gel) or retina — caused by Aspergillus. It can lead to:

• Red, painful eye

• Blurred or lost vision

• Eye inflammation, sometimes with “filamentous” fungal growth on the lens if post-surgery

• Both exogenous (from cataract surgery or injury) and endogenous (spread through the blood, often in immunocompromised patients) forms exist

📉 How Rare Is It?

• Aspergillus causes fewer than 1% of postoperative eye infections

• Even among fungal cases, it’s a leading but still uncommon cause

🧬 Who Is at Risk?

• Immunocompromised individuals (e.g., transplant, high-dose steroids, cancer infusion, diabetes, HIV)

• Post-operative or post-trauma eye patients, especially cataract surgery

• IV drug users, or people with systemic aspergillosis

Despite these risk factors, it remains an uncommon complication.

🩺 Symptoms

• Eye pain and redness

• Blurry or reduced vision

• Sensation of “floaters” or shadows

• Often unilateral, but can be bilateral, especially after surgery or in immunosuppressed patients

🧪 Diagnosis

• Eye examination by an ophthalmologist with slit lamp or ultrasound

• Sampling of vitreous or aqueous fluid for culture, PCR, or galactomannan tests

💊 Current Treatment Guidelines

Based on 2022–2025 evidence:

1. Prompt vitrectomy (surgical removal of infected gel) improves outcomes Intravitreal voriconazole injections (directly into the eye) enhance recovery

2. Systemic antifungals: voriconazole or isavuconazole are preferred; amphotericin B or combination therapy may be used if resistant

3. Prognosis: Vision ≥20/400 in <50% of cases; globe preserved in ~66% of eyes

🧭 Summary for Patients

• Aspergillus endophthalmitis is extremely rare — it affects a tiny fraction of aspergillosis patients.

• It’s often linked to eye surgeries, trauma, or severe immunosuppression.

• Symptoms include pain, redness, floaters, and vision loss — if any appear, seek urgent ophthalmology care.

• Best outcomes result from early vitrectomy, intravitreal antifungals, and systemic treatment.

✅ Bottom Line

While Aspergillus can affect many parts of the body, eye infections (endophthalmitis) are among the rarest forms. Most patients with respiratory forms (ABPA, CPA, or aspergilloma) will never develop this.
But awareness matters — especially for those who are immunocompromised or have had eye surgery. With swift, specialist treatment, many eyes can be saved, though vision recovery is often limited.