Post-COVID-19 Endogenous Fungal Endophthalmitis: An Emerging Threat to Ocular Health

Farah Khatib^* Department of Ophthalmology, Eastern Institute of Medical Sciences, Doha, Qatar
^*Correspondence: Farah Khatib, Department of Ophthalmology, Eastern Institute of Medical Sciences, Doha, Qatar, Email:

Received: 26-Feb-2025, Manuscript No. JOII-25-29236 ; Editor assigned: 28-Feb-2025, Pre QC No. JOII-25-29236 (PQ); Reviewed: 14-Mar-2025, QC No. JOII-25-29236 ; Revised: 21-Mar-2025, Manuscript No. JOII-25-29236 (R); Published: 28-Mar-2025, DOI: 10.35248/JOII.25.06.126

Description

The COVID-19 pandemic introduced several complications extending beyond respiratory illness. In recent months, clinicians have observed a surge in cases of endogenous fungal Endophthalmitis, particularly among individuals recovering from COVID-19 [1]. This opportunistic ocular infection, although rare prior to the pandemic, is now being increasingly documented in immunocompromised or steroid-treated patients who previously battled SARS-CoV-2. The global burden of fungal infections like those caused by Candida, Aspergillus and Fusarium species is not new, but their ocular implications have drawn significant attention only recently [2].

Endogenous fungal Endophthalmitis involves haematogenous spread of fungal organisms to intraocular tissues, often resulting in significant visual morbidity. The condition can present sub acutely, typically with symptoms such as floaters, blurred vision, ocular pain and redness. Post-COVID-19 patients, particularly those admitted to intensive care units or treated with systemic corticosteroids, exhibit a heightened susceptibility due to impaired host immune responses and mucosal barrier breaches [3].

Recent case series have indicated that the onset of symptoms can occur within 2–4 weeks’ post-hospitalization. Fundus examination may reveal fluffy, white chorioretinal lesions, often associated with vitrifies [4]. The diagnostic process, while challenging, heavily relies on clinical suspicion, imaging such as B-scan ultrasonography in media opacity and microbiological confirmation through vitreous aspirate analysis. Polymerase chain reaction (PCR)-based assays have improved pathogen detection rates, aiding in early targeted therapy [5].

One concerning observation is the diagnostic delay in many of these cases. Ocular complaints in post-COVID-19 patients are often misattributed to uveitis, conjunctivitis, or medication side effects. Delays in diagnosis can be detrimental, as fungal Endophthalmitis requires early and aggressive intervention to salvage vision. Intravitreal antifungal injections, such as voriconazole or amphotericin B, in combination with systemic antifungals like fluconazole or caspofungin, form the mainstay of treatment. In many cases, pars plane vitrectomy is required to control infection, reduce fungal load and improve drug penetration [6].

The emergence of multidrug-resistant fungal strains poses additional therapeutic challenges. There is increasing concern about the efficacy of conventional antifungal agents against newer or less common species isolated in ocular samples post-COVID-19. Furthermore, the cost and availability of advanced antifungal medications remain significant barriers in low-resource settings [7].

Several retrospective and prospective studies are currently underway to better understand the pathophysiological mechanisms linking COVID-19 to secondary fungal infections. The prevailing hypothesis suggests that systemic immune dysregulation, endothelial damage and altered ocular perfusion may create a favourable environment for fungal seeding. Patients with diabetes, cancer, organ transplants and those on prolonged corticosteroids are at particular risk [8].

The ophthalmology community must respond to this new threat by updating screening protocols for post-COVID patients. Early ophthalmic evaluations in at-risk individuals can facilitate the prompt detection of ocular complications. Public health authorities and hospital infection control teams must work together to ensure adequate infection prevention, especially in ICU settings, where many fungal spores may originate from contaminated surfaces, humidifiers, or central lines [9].

Beyond clinical management, raising awareness among general physicians and internists is critical. Ocular complaints in recovered COVID-19 patients must not be underestimated. Educational initiatives and training programs for early referral can significantly reduce the burden of preventable blindness due to fungal Endophthalmitis [10].

Conclusion

post-COVID-19 endogenous fungal Endophthalmitis represents a growing ocular emergency. This secondary complication is likely underreported and underestimated in both developed and developing nations. A multi-disciplinary approach involving early recognition, diagnostic vigilance and aggressive therapy is essential to combat this emerging threat. As global health systems continue to recover from the pandemic’s acute phase, attention must be paid to the lingering effects, especially those that may silently compromise vision and quality of life.

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