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FUNGAL KERATITIS
By:Sina Motallebi
M.Optom(2nd Sem)
Amity Medical School
 A fungus is any member of a large group of
eukaryotic organisms that includes microorganisms
such as yeasts and molds,as...
Fungal Keratitis is caused when Fungi gain access
into the corneal stroma through a defect in the
epithelium, then multipl...
Causes
 It is caused due to Aspergillus,Fusarium
and Candida albicans fungus.More
commonly by Apergillus.
 Its often see...
Risk factors
 Trauma (eg, contact lenses, foreign
body).
 Topical corticosteroid use.
 Corneal surgery such as penetrat...
 Previous history of trauma (vegetable
matter).
 Agricultural occupations.
Workup
Laboratory:
 Corneal scrapings are obtained using a
platinum spatula, surgical blade, or
calcium alginate swab ino...
Symptoms
 Foreign body sensation.
 Increasing eye pain or discomfort.
 Sudden blurry vision.
 Unusual redness of the e...
 Excessive tearing and discharge from the
eye.
 Increased light sensitivity.
Signs
 Conjunctival injection.
 Epithelial defect.
 Stromal infiltration.
 Suppuration
 Hypopyon
Presenting clinical features:
 Fine or coarse granular infiltrate within the epithelium and
anterior stroma.
 Gray-white...
Ophthalmic imaging:
 If clinical evidence or suspicion of
posterior segment involvement exists,
ophthalmic B-scan ultraso...
Other tests:
 Immunofluorescence staining.
 Electron microscopy.
 Confocal microscopy- It may help in correctly
diagnos...
Treatment
Medical care:
Antifungal agents are classified into the following groups:
 Polyenes include natamycin, nystatin...
 Natamycin is the only commercially available
topical ophthalmic antifungal preparation. It is
effective against filament...
 Azoles (imidazoles and triazoles) include
ketoconazole, miconazole, fluconazole,
itraconazole, econazole, and clotrimazo...
Biomicroscopic signs to assess he
efficacy of the medications being
used:
 Blunting of the perimeters of the infiltrate.
...
 Reduction in anterior chamber
inflammation.
 Progressive reepithelization.
 Loss of the feathery perimeter of the
stro...
Surgical care:
 Patients who do not respond to medical
treatment of topical and oral antifungal
medications usually requi...
 Approximately one third of fungal infections fail
to respond to medical treatment and may result
in corneal perforation....
 The main goals of surgery are to control the
infection and to maintain the integrity of the
globe.
 Topical antifungal ...
References
 Vaddavalli PK, Garg P, Sharma S, Sangwan VS, Rao GN,
Thomas R. Role of confocal microscopy in the diagnosis o...
 Ramanjit Sihota,Radhika Tandon(eds);Parson’s Diseases of
the Eye;15;199-200.
THANK YOU
Fungal keratitis
Fungal keratitis
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Fungal keratitis

Disease

Fungal keratitis

  1. 1. FUNGAL KERATITIS By:Sina Motallebi M.Optom(2nd Sem) Amity Medical School
  2. 2.  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 familiar mushrooms.  Many species produce bioactive compounds called mycotoxins, such as alkaloids and polyketides, that are toxic to animals including humans. Fusarium Candida albicans
  3. 3. 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.
  4. 4. Causes  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.
  5. 5. Risk factors  Trauma (eg, contact lenses, foreign body).  Topical corticosteroid use.  Corneal surgery such as penetrating keratoplasty, clear cornea (sutureless) cataract surgery, photorefractive keratectomy, or laser in situ keratomileusis (LASIK)
  6. 6.  Previous history of trauma (vegetable matter).  Agricultural occupations.
  7. 7. Workup Laboratory:  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 growth.
  8. 8. Symptoms  Foreign body sensation.  Increasing eye pain or discomfort.  Sudden blurry vision.  Unusual redness of the eye.
  9. 9.  Excessive tearing and discharge from the eye.  Increased light sensitivity.
  10. 10. Signs  Conjunctival injection.  Epithelial defect.  Stromal infiltration.
  11. 11.  Suppuration
  12. 12.  Hypopyon
  13. 13. Presenting clinical features:  Fine or coarse granular infiltrate within the epithelium and anterior stroma.  Gray-white color, dry, and rough corneal surface that may appear elevated.  Typical irregular feathery-edged infiltrate.  White ring in the cornea and satellite lesions near the edge of the primary focus of the infection.
  14. 14. Ophthalmic imaging:  If clinical evidence or suspicion of posterior segment involvement exists, ophthalmic B-scan ultrasound may be necessary to rule out concurrent fungal endophthalmitis.
  15. 15. Other tests:  Immunofluorescence staining.  Electron microscopy.  Confocal microscopy- It may help in correctly diagnosing early stages of fungal keratitis and in monitoring disease progress at the edges and depth.
  16. 16. Treatment Medical care: 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.
  17. 17.  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 corneal infection.
  18. 18.  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.
  19. 19. Biomicroscopic signs to assess he efficacy of the medications being used:  Blunting of the perimeters of the infiltrate.  Reduction of the density of the suppuration.  Reduction in cellular infiltrate and edema in the surrounding stroma.
  20. 20.  Reduction in anterior chamber inflammation.  Progressive reepithelization.  Loss of the feathery perimeter of the stromal inflammation.
  21. 21. Surgical care:  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.
  22. 22.  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 necessary.
  23. 23.  The main goals of surgery are to control the infection and to maintain the integrity of the globe.  Topical antifungal therapy, in addition to systemic fluconazole or ketoconazole, should be continued following penetrating keratoplasty.
  24. 24. References  Vaddavalli PK, Garg P, Sharma S, Sangwan VS, Rao GN, Thomas R. Role of confocal microscopy in the diagnosis of fungal and acanthamoeba keratitis. Ophthalmology. Jan 2011;118(1):29-35.  Dunlop AA, Wright ED, Howlader SA, Nazrul I, Husain R, McClellan K. Suppurative corneal ulceration in Bangladesh. A study of 142 cases examining the microbiological diagnosis, clinical and epidemiological features of bacterial and fungal keratitis. Aust N Z J Ophthalmol. May 1994;22(2):105-10.  Kanski J Jack;Clinical ophthalmology a systemic approach;6th edition;butterworth and heinnmen.
  25. 25.  Ramanjit Sihota,Radhika Tandon(eds);Parson’s Diseases of the Eye;15;199-200.
  26. 26. THANK YOU

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