A fungal corneal ulcer is caused by a fungal infection of the cornea. Common causative organisms include Candida, Aspergillus, Fusarium, and others. Symptoms include pain, photophobia, blurred vision, and redness. Signs include a greyish-white ulcer with feathery extensions into the stroma. Diagnosis involves corneal scraping for KOH, Gram, or calcofluor white staining to identify fungal hyphae. Treatment consists of topical antifungal drops like natamycin or amphotericin B for 6-8 weeks, sometimes with adjunctive cycloplegics, analgesics, or systemic antifungals for severe cases. Unresponsive cases

1. MYCOTIC / FUNGAL
CORNEAL ULCER

3. CORNEAL ULCER
“It is defined as discontinuation of corneal
epithelium associated necrosis of
surrounding tissue”

4. FUNGAL CORNEAL ULCER:
A fungal keratitis is an inflammation of
the cornea (called keratitis) that result
from infection by a fungal organism.
Keratomycosis is the Greek terminology
equivalent of fungal keratitis. It is the
fungal infection of the cornea.

5. PATHOLOGY OF CORNEAL ULCER

6. •
•
•

7. CAUSATIVE ORGANISM
Yeasts
 Candida albicans
 Cryptococcus
Filamentous
Aseptate
Rhizopus
Septate
I. Aspergilus
II. Curvularia
III. Fusarium
IV. Cladosporium
“FUNGI”
Dimprphic
 Histoplasma
 Coccidioides
 Blastomyces

8. ASEPTATE FUNGAL
HYPHAE (GRAM STAIN)
FUNGAL HYPHAE
(LPCB)

9. ASPERGILUS(SDA) FUSARIUM(SDA)

10. FUNGAL HYPHAE
(CALCOFLORITE)

11. MODE OF INFECTION
• Injury by vegetative material
- Seen in Field Workers
• Injury by Animal Tail
• Secondary fungal Ulcer
- Dry eyes,
- Herpetic keratopathy,
- Bullous Keratopathy,
- Post operative cases.

12. •

13. CLINICAL FEATURES

14. Hypopyon
Infiltration
Conjunctival
Hyperaemia
Lid swelling

15. • 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

16. SIGNS
Corneal ulcer - Greyish white
- Dry looking
- Elevated rolled out margin
Delicate Feathery finger like extentions
present into the stroma under intact
epithelium
Sterile immune ring (Stromal ring
infiltration)

17. Satellite lesion
Endothelial plaque (Fibrin and Leucocytes)
Hypopyon - Non sterile
- Large
Perforation (Rare)
Corneal vascularisation

18. Feathery
margin
Elevated
surface

19. Stromal
ring
infiltration

20. DIAGNOSIS
Clinical diagnosis
• Typical Clinical Manifestation
• Chronic Ulcers
• Confocal Microscopic Examination

21. Fungal
hyphae in
confocal
microscope

22. INVESTIGATION
Sample for Examination
1.Corneal scraping
2.Corneal biopsy
3.Anterior Chamber
Paracentesis
Tests Carried out are
KOH stain
Gram stain
Giemsa stain
Lactophenol cotton blue
Culture on Sabouraud
dextrose agar
PCR

23. TREATMENT
Definitive Treatment (using antifungals)
1.Topical antifungal eye drops (6 to 8 weeks)
- For filamentous fungi – Natamycin (5%) - DOC
- Amphotericin B (0.1 to 0.3%)
- Fluconazole (0.2%)
- Miconazole (10mg/ml)
- Voriconazole (10%)
Taper over 6 to 8 weeks
- For Yeasts – Amphotericin B - DOC
- Nystatin (3.5%) eye ointment, 5 times daily
}
One
hourly,
around
the
clock

24. 2. Intracameral and Intracorneal/Intrastromal
- Voriconazole (in case of anterior
chamber involvement.)
3. Systemic antifungal drugs
(in severe cases of deeper fungal keratitis)
- Tab. Fluconazole
- Tab. Ketoconazole
- Tab. Voriconazole
For 3 weeks

25. B. Adjunctive/concurrent therapy
(Non specific treatment)
- Cycloplegic drugs
- Systemic analgesics and anti-inflamatory
- Vitamins (A,B-complex and C)
C. Therapeutic Penetrating Keratoplasty
For non responsive cases