Ocular involvement in patients with fungal infections.

Autopsy findings of 133 patients who died following fungemia or with invasive fungal infection were reviewed. Common clinical factors included antibiotic therapy, chemotherapy, corticosteroid administration, hyperalimentation, malignancy, and bone marrow transplantation. Fungal infection was seldom diagnosed antemortem and fungemia was detected in only 24 patients (18%). Ocular involvement occurred in 14 patients (Candida 11, Aspergillus 2, and Cryptococcus 1). The eye was the fifth most commonly involved organ at autopsy among patients with candida infection. Ocular involvement occurred with a significantly greater frequency in patients with Candida tropicalis than with Candida albicans infections (P less than 0.05). Although only about 10% of patients with fungal infections had ocular involvement, all those with ocular lesions had widely disseminated disease. Realizing the potential toxicity of antifungal therapy, we recommend that screening ophthalmologic examinations be performed on patients with fungemia or patients at high risk for development of fungal infection. The presence of ocular lesions consistent with fungal disease, in the appropriate setting, is a strong indication for investigation of possible systemic fungal infection and therapy once a definitive diagnosis is established.