Sushant shah2nd year Bsc. optometry

Nethradhama college of optometry

Fungal Keratitis

FUNGAL KERATITIS OR KERATOMYCOSIS

Introduction

A fungal keratitis is an 'inflammation of the eye's cornea' (called keratitis) that results from infection by a fungal organism.

One of the major cause of infectious keratitis in tropical countries

• Typically seen after injury with vegetable matter , use of contact lens

Predisposing factorsinjury with vegetable matter

Predisposing factors contd..• use of contact lens

Causative organisms

Hyaline Filamentous fungi – Aspergillus , Penicillum , Fusarium

Dematiacious filmentous fungi - Culvularia, Cladosporium Yeast – Candida albicans

Epidemiology

Aspergillus species is the most common organism responsible for fungul keratitis world wide .

Aspergillus: 27-64 % Fusarium: 6-32 %

Penicillum: 2-29 %

Pathogenesis

Clinical features • Slow progression• Signs more & Symptoms less

Symptoms

• Defective vision • Photophobia • Watering • Marked ciliary & conjunctival congestion

Signs

• Corneal ulcer• Dry looking ulcer with irregular border• Satellite lesions around ulcer• Hypopyon – thick & immobile• Wesseley ring – deposition of immune

complexes & inflammatory cells

Clinical features contd..

Wesseley ring

Hypopyon

Diagnosis

• Careful clinical evaluation correlating typical history, symptoms and signs

• Culture of corneal scrapping

• USG – endophthalmitis – exudates in the vitreous

Suggested Lab Workup

KOH wet mount with or without stain . Gram staining. LCB Culture in SDA(sabooraud's dextrose agar) and blood agar

Treatment

Medical

Filamentous fungi – Natamycin Amphoterecin B Miconazole ointment Yeast – Nystatin Amphotericin

Surgical •Corneal graft•Covered with conjunctival flap