Endogenous coccidioidal endophthalmitis.

Coccidioidomycosis is generally a self-limited respiratory illness. The literature indicates ocular involvement is rare, usually confined to the anterior segment and adnexa. Ten consecutive patients with chronic pulmonary and disseminated disease referred for chemotherapy represent the first prospective study of ocular involvement. Four demonstrated presumed coccidioidal dissemination to the posterior segment without significant vitreous or anterior segment involvement. Juxtapapillary choroiditis was seen in three, including one who demonstrated retinal infiltrates, telangiectatic capillary change, and macular edema on fluorescein angiography. Another developed a coccidioidal lid granuloma. Correlation between intraocular involvement and systemic outcome was poor. Systemic amphotericin B appeared more effective than miconazole in treating intraocular disease in two patients. Intraocular involvement in progressive coccidioidomycosis appears more common than previously reported. Serial eye examinations should be performed on patients with chronic pulmonary or disseminated coccidioidomycosis.