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  • Fallout From the Opioid Crisis: IV Drug Abuse and Endogenous Fungal Endophthalmitis

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD
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    Journal Highlights

    JAMA Ophthalmology
    2017;135:534-540

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    Abuse of intravenous (IV) drugs is a risk factor for endogenous fungal endophthalmitis (EFE), a severe vision-threatening intraocular infection. Tirpack et al. updated the character­istics, management, and visual out­comes among patients with EFE and found that this infection signals severe end-organ damage and poor visual outcomes.

    For this study, the authors reviewed records for all patients with EFE referred to New England Eye Center at Tufts Medical Center from May 2014 to May 2016. Patients with a history of IV drug abuse and clinical evidence or culture proof of fungal endophthalmitis were included. Patient data were collected, including demographics, comorbidi­ties, presenting symptoms, vitreoretinal findings, treatment regimens, culture results, and visual acuity (before and after treatment).

    Ten patients with EFE related to IV drug abuse were identified during the study window period. Their mean age was 34 years (range, 24-60 years), and 50% were female. Presenting visual acuity ranged from 20/25 to hand mo­tion. All patients were ambulatory at presentation, and 90% had isolated ocular symptoms but no systemic sign of infection. The most common pre­senting symptoms were floaters (n = 8), reduced vision (n = 6), and pain (n = 5). Initial treatment included systemic antifungals (all patients) and intravitreal antifungals (9 eyes). Pars plana vitrectomy was performed in 5 patients because of worsening vitritis. The most commonly isolated pathogen was Can­dida albicans. After treatment, visual acuity ranged from 20/40 to 20/300.

    As the opioid crisis continues in the United States, clinicians should maintain a high degree of suspicion for EFE, the authors noted, as patients are ambulatory at presentation and may not have systemic signs of infection.

    The original article can be found here.