Fungal corneal ulcer 3rd yr
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Fungal corneal ulcers have increased due to overuse of antibiotics and steroids. They are commonly caused by Aspergillus, Candida, and Fusarium fungi entering through injuries. Clinical features include pain, photophobia, and a dry, grey-white ulcer with feathery extensions. Diagnosis involves KOH wet mount, cultures, and confocal microscopy of corneal scrapings. Treatment involves topical natamycin or amphotericin B eye drops for 6-8 weeks, sometimes with intrastromal voriconazole or systemic antifungals. Cycloplegics and analgesics may also be used. Therapeutic keratoplasty is needed for non-responsive cases.
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Diabetic Retinopathy
Diabetic retinopathy is a disease that damages the blood vessels of the light-sensitive tissue at the back of the eye (the retina). It is the leading cause of blindness among American adults aged 20-74. Nearly half of all diabetics have some signs of retinopathy. Early detection and treatment can help prevent vision loss from the disease. Controlling blood sugar levels, laser treatments, and vitrectomy surgery are common treatments used to manage diabetic retinopathy.
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- 1. Fungal corneal ulcer By Glin Luckose Fernandez
- 2. The incidence of fungal corneal ulcer has increased during the recent years due to injudicious use of antibiotics and steroids
- 3. Contents • Etiology • Modes of infection • Role of antibiotics and steroids • Clinical features • Diagnosis • Treatment
- 4. Etiology Filamentous fungi : eg :: Septate : Aspergillus , Penicillium, Fusarium :: Aseptate : Mucor , Rizopus • Yeast : eg :: Candida , Cryptococcus • Dimorphic fungi : eg :: Histoplasma , Coccidioides , Blastomyces Most commonly mycotic corneal uncler is caused by : Aspergillus , Candida , Fusarium
- 5. Modes of Infection • Injury by vegetative material : corp leaf , branch of tree , straw , hay- commonly affects field workers especially during harvesting seasons. • Injury by animal tail • Secondary fungal ulcers: common in immunosupresed ,in patients with dry eye , herpetic ulcer , bullous keratopathy or post operative cases of keratoplasty
- 6. Role of antibiotics and steroids • Antibiotics disturbs the symbiosis between bacteria and fungi and steroids make fungi facultative pathogen. • Excessive use of them predisposes the patients to fungal infection
- 7. Clinical features • Symptoms : *Pain , foreign body sensation – due to mechanical effects of lids and chemical effects of toxins on exposed nerve ending *Watering of eyes – due to reflex lacrimation * Photophobia – intolerance to light due to stimulation of nerve ending * Blurred vision – due to corneal haze * Redness – congession of circumcorneal vessels
- 8. Clinical features (cont..) Signs: • Corneal ulcer is dry looking, greyish white, with elevated role margins • Pigmented ulcer :caused by dermatiaceous fungi • Feathery finger like extension into stroma under the intact epithelium • Sterile immune ring : where fungal antigen and host antibodies meet
- 9. Clinical features (cont..) Signs( cont..) • Multiple small satellite lesions around the ulcer • Big hypopion – not sterile ( fungi can penetrate into the anterior chamber) • Endothelial plague – composed of fibrin and leucocytes , under stromal lesion • Perforation ( rare) • Corneal vascularization is absent
- 10. Diagnosis • By typical clinical manifestation with history of injury by vegetative material • Chronic ulcer worsen with most effective treatment – suspicion of mycotic involvement • Lab Diagnosis : Wet KOH, Colcoflour white, Grams stain , Culture on Sabourauds agar media • Confocal microscopic examination • PCR Sample Collection : Corneal scraping – from base and edge Anterior chamber parancentesis Corneal biopsy
- 11. Treatment • Specific Treatment: * Topical antifungal eye drops -for 6 to 8 week- Natamycin (5%), Amphotericin B( 0.1% to 3%)- for every 1 hr initially then tapered over 6 to 8 weeks; Nystatin (3.5%) eye ointment 5 times a day. * Intracorneal or intrastromal administration- of voriconazole in cases intraocular extension or anterior chamber . * Systemic antifungal – in sever cases of deeper fungal keratitis- tablet fluconazole or ketoconazole for 2 -3 weeks
- 12. Treatment ( cont..) • Nonspecific : * Cycloplegic drugs : 1% atropin , homatropine 2% - to reduce pain from cilliary spasm - to prevent posterior scynechiae from secondary iridoclyclitis. - Increace blood supply to relieve pressure and bring more antibodies in aqueous humour - reduce exudation by decreasing hyperemia and vascular permeabily * Systemic analgesics and anti inflammatory – paracetamol and ibuprofen • Therapeutic penatrating keratoplasty - for nonresponsive cases
- 13. For