Ocular features in sepsis - a scoping review

TL;DR

This review explores eye-related symptoms in sepsis patients and highlights the importance of early detection to prevent vision loss.

Contribution

The study provides a global overview of ocular manifestations in sepsis and identifies key pathogens and clinical patterns.

Findings

Fungal infections like Candida albicans are the leading cause of ocular involvement in sepsis.

Posterior segment eye issues like chorioretinitis are most commonly reported in sepsis patients.

Early detection and combined ocular and systemic treatment can improve outcomes in sepsis patients with eye symptoms.

Abstract

This review aimed to provide a comprehensive overview of the types of ocular manifestations observed in patients suffering from systemic sepsis including modifications in management of sepsis with ocular involvement.

Sepsis is a life-threatening condition resulting in widespread organ dysfunction, driven by dysregulated host responses to infection. In patients with altered sensorium or impaired communication, timely detection of ocular involvement becomes particularly challenging. Delays in recognition can lead to irreversible visual loss, underscoring the need for early ophthalmic evaluation in this population.

This review included adult patients (aged > 18 years) from a global population who exhibited ocular manifestations in the context of systemic sepsis, defined by Sepsis 2 and Sepsis 3 criteria. Studies focusing solely on pediatric patients, non-septic conditions, or without ocular features were excluded.

A comprehensive search was conducted on December 29, 2025, across four electronic databases—PubMed (MEDLINE), Embase (Elsevier), Scopus (Elsevier), and ProQuest. Boolean operators “OR” and “AND” were applied to combine synonyms and cross-domains related to sepsis and eye disease. Studies published in English from the year 2000 onward were included. Exclusion criteria encompassed non-English articles, reviews, conference abstracts, non-sepsis-related conditions, and non-human or cell-based studies.

Of 2276 articles screened, 22 met the inclusion criteria. These comprised case reports, case series, and observational studies from diverse global settings. Fungal infections, particularly Candida albicans, emerged as the leading cause of ocular involvement, followed by Staphylococcus aureus and Klebsiella pneumoniae. Posterior segment findings such as chorioretinitis and vitritis were most frequently reported. Anterior segment and periocular signs were infrequently reported in studies.

Ocular manifestations constitute a serious complication in sepsis, with visual impairment and posterior segment involvement commonly originating from bacterial and fungal infections, often stemming from the urinary tract. Early detection in sepsis patients with positive blood cultures, combining ocular and systemic interventions, can improve outcomes.

The online version contains supplementary material available at 10.1186/s12886-026-04647-6.

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