Beyond COVID-19 Paradigm: Devastating Rare Fungal Ocular Complication

Abstract

Ocular involvement in COVID-19 is rare and often mild. We report a case of severe bilateral ocular candidiasis post-COVID-19 infection. A male, 48 years old, suffered from sudden blurry vision in the right eye (RE). The patient had a history of COVID-19, ICU stay, ventilator use, and a hypercoagulable state. The patient had a history of tocilizumab and steroid use. The initial best corrected visual acuity (BCVA) was 6/30 (RE), with progressive worsening of light perception and 6/6 on the left eye (LE) to 3/60. Examination revealed string-of-pearls and snowball on vitreous, fibrovascular tissue with exudates and subretinal fluid on the macula. Tractional retinal detachment was found in both eyes, and these findings were consistent with fungal endophthalmitis. Culture was taken from a chest lump and it was positive for Candida albicans. The patient was diagnosed with bilateral ocular candidiasis and treated with a 14-day course of intravenous voriconazole and vitrectomy. The final BCVA was hand movement (RE) and 6/45 (LE).