Iris abscess a rare presentation of intravenous drug abuse associated Candida endophthalmitis

PURPOSE: To describe an unusual case of intravenous drug abuse associated endogenous endophthalmitis presenting with an iris abscess. OBSERVATIONS: A 30-year old female with history of intravenous drug use presented with a two-week history of redness and blurry vision in the right eye. An initial diagnosis of anterior uveitis was made. However, she worsened on topical steroids and mydriatics. She was found to have a hypopyon and an iris abscess. She received broad spectrum antibiotic and antifungal treatment with voriconazole, this lead to significant clinical improvement. She was discharged on oral fluconazole and lost to follow up. The patient was noncompliant with the antifungal treatment. The hypopyon and iris abscess recurred, and she required a vitrectomy with iridectomy, along with intravitreal and systemic antifungal treatment. The vitreous cultures and surgical specimen of iris issue were positive for Candida albicans, and she received voriconazole. This led to resolution of the condition with a final visual acuity of 20/20 at six month follow up. CONCLUSIONS AND IMPORTANCE: An iris abscess is a rare clinical presentation of intravenous drug use-associated endogenous endophthalmitis and as a result may present a diagnostic challenge as it requires a high level of clinical suspicion and a detailed social history to elicit the drug abuse. Early diagnosis and aggressive therapy is the key to better visual outcomes in these patients.