Question: Is an ophthalmology consult indicated in all patients with candidemia?
Review: The Infectious Disease Society of America (IDSA) Practice Guidelines for Candidiasis  recommend ophthalmological examination in all patients with candidemia, regardless of age, immune competency, symptoms, or ability to communicate. It is not clear to me from reading the guidelines what evidence exactly that recommendation is based on. Two studies reviewed [1, 2] address this topic and found very low rates (less than 1 to 2%) of ocular involvement in fungemic patients, and concluded that asymptomatic, communicative patients with candidemia who are being adequately treated with an anti-fungal regimen may not require fundoscopic examination. Prospective studies, and thus, more definitive evidence on this topic are lacking.
Answer: The safe thing to do is to get the patient’s eyes examined. If consultation resources are spread thin, the ophthalmologic exam on an asymptomatic candidemic patient may be a low priority. More studies are needed.