Ocular Infections in Transplant Patients

Ocular infections in transplant patients can be rapidly progressive and result in significant vision loss and morbidity. Approximately 2% of transplant patients in several large series developed serious eye infections, and the most common were viral retinitis and fungal endophthalmitis. Viral retinitis is due to cytomegalovirus, herpes simplex, or herpes zoster. A particularly fulminant form of viral retinitis, progressive outer retinal necrosis, may occur and result in blindness within 1 to a few days. Hematogenous spread of bacterial and fungal infections to the eye may result in endophthalmitis. Ocular infections that occur in non-immunocompromised patients also occur in the transplant population, and these include keratitis (infection of the cornea), herpes zoster ophthalmicus, and ocular toxoplasmosis. Invasive fungal infections involving the orbit, such as rhinocerebral mucormycosis, are seen in transplant patients as they are in other immunocompromised patients. In transplant patients, sometimes the first signs of a life-threatening systemic infection occur in the eye. Patients with fungemia, for example, may present with vision loss from fungal endophthalmitis. Eye infections in the transplant population are important to diagnose promptly both to prevent irreversible vision loss, which may occur very quickly in the immunocompromised host, and to recognize an underlying systemic infection that may be life-threatening.