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Amity Medical School
A fungus is any member of a large group of
eukaryotic organisms that includes microorganisms
such as yeasts and molds,as well as the more
Many species produce bioactive compounds called
mycotoxins, such as alkaloids and polyketides, that
are toxic to animals including humans.
Fusarium Candida albicans
Fungal Keratitis is caused when Fungi gain access
into the corneal stroma through a defect in the
epithelium, then multiply and cause tissue necrosis
and an inflammatory reaction.
It is caused due to Aspergillus,Fusarium
and Candida albicans fungus.More
commonly by Apergillus.
Its often seen after injury with vegetable
matter such as a thorn or a wooden stick.
Trauma (eg, contact lenses, foreign
Topical corticosteroid use.
Corneal surgery such as penetrating
keratoplasty, clear cornea (sutureless)
cataract surgery, photorefractive
keratectomy, or laser in situ
Previous history of trauma (vegetable
Corneal scrapings are obtained using a
platinum spatula, surgical blade, or
calcium alginate swab inoculated on
Sabouraud agar plates, and then
maintained at 25°C to enhance fungal
Foreign body sensation.
Increasing eye pain or discomfort.
Sudden blurry vision.
Unusual redness of the eye.
Excessive tearing and discharge from the
Increased light sensitivity.
Presenting clinical features:
Fine or coarse granular infiltrate within the epithelium and
Gray-white color, dry, and rough corneal surface that may
Typical irregular feathery-edged infiltrate.
White ring in the cornea and satellite lesions near the edge
of the primary focus of the infection.
If clinical evidence or suspicion of
posterior segment involvement exists,
ophthalmic B-scan ultrasound may be
necessary to rule out concurrent fungal
Confocal microscopy- It may help in correctly
diagnosing early stages of fungal keratitis and in
monitoring disease progress at the edges and
Antifungal agents are classified into the following groups:
Polyenes include natamycin, nystatin, and
amphotericin B. Polyenes disrupt the cell by
binding to fungal cell wall.
Amphotericin B is the drug of choice for
treatment of fungal keratitis caused by Candida.
Natamycin is the only commercially available
topical ophthalmic antifungal preparation. It is
effective against filamentous fungi, particularly
for infections caused by Fusarium.
However, because of poor ocular penetration, it
has primarily been useful in cases with superficial
Azoles (imidazoles and triazoles) include
ketoconazole, miconazole, fluconazole,
itraconazole, econazole, and clotrimazole.
Azoles inhibit ergosterol synthesis at low
concentrations, and, at higher concentrations,
they appear to cause direct damage to cell walls.
Biomicroscopic signs to assess he
efficacy of the medications being
Blunting of the perimeters of the infiltrate.
Reduction of the density of the
Reduction in cellular infiltrate and edema
in the surrounding stroma.
Reduction in anterior chamber
Loss of the feathery perimeter of the
Patients who do not respond to medical
treatment of topical and oral antifungal
medications usually require surgical intervention,
including corneal transplantation.
Frequent corneal debridement with a spatula is
helpful; it debulks fungal organisms and
epithelium and enhances penetration of the
topical antifungal agent.
Approximately one third of fungal infections fail
to respond to medical treatment and may result
in corneal perforation. In these cases, a
therapeutic penetrating keratoplasty is
The main goals of surgery are to control the
infection and to maintain the integrity of the
Topical antifungal therapy, in addition to systemic
fluconazole or ketoconazole, should be continued
following penetrating keratoplasty.
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