Fungal

• Fungal keratitis is an uncommon but aggressive corneal infection.

  It is a major cause of visual loss in developing and tropical countries.
• Common organisms:

  • Fusarium
  • Aspergillus
  • Candida in the immunocompromised
• Risk factors for fungal keratitis include:

  • Corneal trauma: especially with contamination of organic/agricultural matter
  • Contact lens wear
  • Immunosuppression: topical steroids, systemic immunosuppression, diabetes
  • Ocular surface disease: dry eyes
• Typical symptoms of fungal keratitis are similar to other corneal infections. There is a gradual onset of pain, redness, reduced visual acuity, photophobia and epiphora (purulent but less than bacterial)
• Clinical findings:

  • Redness and periocular oedema of lids and lashes
  • Diffuse injection of the conjuctiva
  • Cornea - grey/white stromal infiltrate with fluffy margins. Satellite lesions
  • Hypopyon
• Relevant investigations may include:

  • Corneal scraping, performed early, before commencing treatment: for Gram and Giemsa staining and for culture, plated on Sabouraud dextrose agar
  • PCR analysis
• Management:

  • Topical antifungals
  • Systemic antifungals in severe cases, suspected endophthalmitis and immunocompromised patients
  • Penetrating keratoplasty (full-thickness corneal transplant) may be required in progressive disease.
• Endophthalmitis is a purulent inflammation of the intraocular fluids (vitreous and aqueous) usually due to infection.
• Visual prognosis is generally poor due to the high rate of complications. Recurrence is common following tapering of treatment.

  Other complications may include:

  • Severe inflammatory response leading to scleritis and endophthalmitis
  • Corneal perforation