Nikhil Prasad Fact checked by:Thailand Medical News Team Mar 01, 2026 2 hours, 29 minutes ago
Thailand Medical: A major study from southern Thailand is shedding new light on a little-known but potentially devastating complication of bloodstream fungal infections—serious eye damage that can occur silently and without warning.
A Thai hospital study reveals that dangerous eye infections from bloodstream fungi are often silent but frequently require major treatment changes once detected
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Researchers from the Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand, conducted a large retrospective cohort study at Songklanagarind Hospital, a 900-bed tertiary-care university center. Their goal was to determine how often Candida bloodstream infections spread to the eyes, how frequently patients receive proper eye examinations, and whether these examinations actually change treatment decisions.
This
Thailand Medical News report examines their important findings and what they could mean for patient care in Thailand and across Southeast Asia.
Understanding the Hidden Risk
Candidemia is a serious infection where Candida fungi enter the bloodstream. It primarily affects hospitalized patients, especially those who are critically ill or immunocompromised. While the infection itself is life-threatening, it can also spread to organs such as the eyes, causing a condition known as ocular candidiasis.
Ocular candidiasis can lead to inflammation of the retina (chorioretinitis) or a more severe internal eye infection called endophthalmitis. If not detected and treated promptly, permanent vision loss can occur.
What the Study Found
Between January 2014 and August 2025, the researchers analyzed 337 patients aged 15 years and older who had confirmed candidemia. Surprisingly, only 67 patients—just 19.9 percent—received an ophthalmic evaluation within four weeks of diagnosis.
Among those who were examined, 9 patients (13.4 percent) were diagnosed with ocular candidiasis. When calculated across the entire group of 337 patients, the overall incidence was 2.7 percent.
Five patients had Candida chorioretinitis, while four were diagnosed with Candida endophthalmitis. Notably, 77.8 percent of affected patients had infection in both eyes, highlighting the aggressive nature of the condition.
Most Patients Had No Visual Symptoms
One of the most striking findings was that most patients with ocular involvement had no eye-related complaints. Out of 35 patients whose symptoms could be assessed, only 4 reported visual disturbances.
This means that relying solely on symptoms would miss the majority of cases. The infection can quietly affect the eyes before patients notice blurred vision or other warning signs.
Treatment Changes After Eye Findings
Ophthalmic evaluations had a meaningful impa
ct on patient management. In 7 out of the 9 patients with ocular candidiasis, doctors modified antifungal therapy after detecting eye involvement.
The most common changes included adding or switching to azole-based antifungal medications and extending the duration of treatment. Two patients required antifungal injections directly into the eye. None required surgical removal of the eye, but some experienced worsening vision despite treatment.
These findings show that eye examinations were not merely routine checks—they frequently led to significant treatment adjustments.
Which Fungi Were Responsible?
The most common bloodstream fungal species identified were Candida tropicalis (40.9 percent) and Candida albicans (30.3 percent). Both species were responsible for eye infections in this study.
Thailand has a higher proportion of non-albicans Candida species compared to Western countries. Despite differences in species distribution and antifungal resistance patterns, the rate of ocular candidiasis among examined patients was comparable to or slightly higher than reports from some Western settings.
Why Were So Few Patients Screened?
The study also explored why ophthalmic evaluations were performed so infrequently. Patients who required vasopressor medications at the onset of candidemia—indicating more severe illness—were significantly less likely to undergo eye examination.
Conversely, early consultation with infectious disease specialists significantly increased the likelihood of receiving an ophthalmic evaluation. This suggests that structured care pathways and multidisciplinary collaboration improve adherence to recommended screening practices.
Mortality and Clinical Implications
Patients who underwent ophthalmic evaluation had lower short-term mortality rates. However, the researchers cautioned that this likely reflects the fact that critically ill patients often died before screening could be arranged. As a result, the true burden of ocular candidiasis may be underestimated.
Conclusions
The findings highlight an important gap in routine clinical practice. Ophthalmic evaluation in patients with candidemia was markedly underutilized, yet when performed, it frequently identified serious, often silent eye infections and led to meaningful changes in antifungal therapy. Because many affected patients had no visual symptoms, symptom-based screening alone is insufficient.
Integrating standardized ophthalmic evaluation into candidemia care protocols—especially in resource-limited settings—may improve early detection, optimize treatment strategies, and help prevent irreversible vision loss. Further prospective studies are needed to better define screening strategies and accurately determine the true incidence of ocular candidiasis in Southeast Asia.
The study findings were published in the peer reviewed Journal of Fungi.
https://www.mdpi.com/2309-608X/12/3/173
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Read Also:
https://www.thailandmedical.news/articles/ophthalmology-(eye-diseases)
https://www.thailandmedical.news/articles/thailand-medical
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