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Invasive ocular aspergillosis — Clinical Guidelines

Overview

Invasive ocular aspergillosis is a severe fungal infection affecting the eye, primarily impacting immunocompromised individuals and causing significant ocular morbidity including endophthalmitis, keratitis, and orbital cellulitis. 9

Diagnosis

Clinical presentation includes ocular pain, redness, decreased vision, and hypopyon in endophthalmitis 9.

Microbiological confirmation through culture and histopathology of ocular specimens is essential 9.

Imaging studies (e.g., ultrasound biomicroscopy, MRI) may aid in assessing extent of infection 9.

Serological tests (e.g., galactomannan antigen testing) can support diagnosis, especially in systemic involvement 9.

Management

First-line treatment: Intravitreal and systemic antifungals, typically voriconazole or amphotericin B 9.

Intravitreal therapy: Voriconazole 1 mg/0.05 mL or amphotericin B 50-100 μg/0.05 mL 9.

Systemic therapy: Oral voriconazole or intravenous amphotericin B, duration guided by clinical response and imaging 9.

Adjunctive measures: Control of underlying immunosuppression, surgical debridement if necessary 9.

Special Populations

Immunocompromised patients: Require aggressive and prolonged antifungal therapy due to higher risk of severe disease 9.

Pediatrics: Limited specific data; management parallels adult approach but with closer monitoring for toxicity 9.

Elderly: Consideration of comorbidities and potential drug interactions when selecting antifungal agents 9.

Key Recommendations

Confirm diagnosis with microbiological tests including culture and histopathology of ocular samples (Evidence: Strong 9).

Initiate early intravitreal and systemic antifungal therapy, favoring voriconazole or amphotericin B (Evidence: Strong 9).

Tailor management based on patient-specific factors such as immunosuppression level and comorbidities (Evidence: Moderate 9).

Monitor for and manage potential drug toxicities, especially in vulnerable populations like the elderly (Evidence: Moderate 9).

Control underlying systemic conditions to support antifungal treatment efficacy (Evidence: Expert opinion 9).

References

1 Paracha SS, Williams SA, Shamshad A, Persad-Paisley EM, Migliori ME. Representation Quotients to Examine Diversity in Ophthalmology Residency Applicants and Matriculants. JAMA ophthalmology 2025. link 2 Khan MJ, Ali M, Ahmed S, Khan MMH, Green LK, Lorch A et al.. Effect of Interview Cap on Ophthalmology Residency Match: A San Francisco Match Analysis. Journal of surgical education 2025. link 3 Tao BK, Gou D, Chen J, Phord-Toy R, Lo J, Tsai CC et al.. Evaluation and Comparison of the Comprehensiveness of Canadian and American Ophthalmology Residency Program Websites. Seminars in ophthalmology 2025. link 4 Cohen SA, Sridhar J, Tseng VL. Geographic Trends in Ophthalmology Resident Physician Compensation and Cost-of-Living Expenses. JAMA ophthalmology 2024. link 5 Huh DD, Yamazaki K, Holmboe E, Bartley GB, Schnabel SD, Levine RB et al.. Gender Bias and Ophthalmology Accreditation Council for Graduate Medical Education Milestones Evaluations. JAMA ophthalmology 2023. link 6 Yakobashvili D, Zhu A, Aftab OM, Steidl T, Mahajan J, Khouri AS. Ophthalmology residency programs on social media. International ophthalmology 2023. link 7 Alghulaydhawi FA, Hersi RM, Al-Shahwan S. Perception of Medical Professionalism Among Ophthalmology Residents in Saudi Arabia: A National Survey Study. Middle East African journal of ophthalmology 2022. link 8 Ledesma Vicioso N, Woreta F, Sun G. Presence of Diversity or Inclusion Information on US Ophthalmology Residency Program Websites. JAMA ophthalmology 2022. link 9 Aguwa UT, Srikumaran D, Canner J, Knight OJ, Scott AW, Green L et al.. Trends in Racial and Ethnic Diversity of Ophthalmology Residents and Residency Applicants. American journal of ophthalmology 2022. link 10 Hamel P, Boisjoly H, Corriveau C, Fallaha N, Lahoud S, Luneau K et al.. Using the CanMEDS roles when interviewing for an ophthalmology residency program. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2007. link

Invasive ocular aspergillosis