Nosocomial Infection and Unilateral Visual Loss due to Ocular Candidiasis in the Intensive Care Unit: A Case Report

Abstract

Introduction: Ocular candidiasis is a rare but serious complication of systemic Candida infection that can spread to the retina and choroid, causing chorioretinitis or endophthalmitis and potentially leading to permanent vision loss if not treated early. Aims: To report a case of presumed endogenous ocular candidiasis in a critically ill patient and highlight the vital role of early multimodal ophthalmic screening and interdisciplinary management within the intensive care unit (ICU) setting. Presentation of Case: A 60-year-old male developed progressive, profound unilateral visual loss in his right eye during ICU hospitalization for a severe primary pulmonary infection complicated by a secondary nosocomial infection. Dilated fundoscopy revealed pathognomonic elevated, creamy-white chorioretinal lesions with fluffy, ill-defined borders and associated vitritis. Fluorescein angiography showed early diffuse hyperfluorescence with progressive late leakage due to blood–retinal barrier breakdown. Optical coherence tomography (OCT) demonstrated marked macular distortion, outer retinal structural irregularities, and subretinal/choroidal hyperreflective lesions. Prompt initiation of systemic antifungal therapy combined with adjunctive systemic corticosteroids resulted in significant anatomical lesion regression and substantial visual recovery. Discussion: Endogenous Candida endophthalmitis is a severe complication of candidemia in ICU patients undergoing central catheterization and broad-spectrum antibiotic therapy. Visual symptoms are frequently masked by life-threatening systemic critical illness. Dilated fundoscopy remains the diagnostic gold standard, complemented by optical coherence tomography (OCT) for non-invasive tracking of retinal pigment epithelium disruption. Highly penetrant systemic azoles are primary therapies; adding systemic corticosteroids post-antifungal initiation safely downregulates destructive intraocular inflammation, preventing irreversible macular scarring. Conclusion: Bedside ophthalmic screening is critical for ICU patients presenting with unexplained visual disturbances and systemic candidemia risk factors. Timely interdisciplinary intervention is essential to preserve long-term macular structure and permanent visual function.