This presentation describes the keratitis caused by fungi ...discussing the etiology, pathogenesis, manifestations and treatment.

1. Fungal keratitis

2. Under the supervision of
Ophthalmology
department of Sohag
University
Dr. Amr Mounir
● by:
● Yasmin Medhat Mohammed.
● Tomas joseph ghabrial
● Hesham ashraf nazmy
● Arej mohamed abd el kader

3. Fungal kiratits

4. Definition :Fungal keratitis is a serious ocular
infection with potentially catastrophic visual results.
Caused by any of the many species of fungi capable
of colonizing human tissue, its occurs worldwide and
its incidence is increasing in frequency.

5. Organism.
1-Yeasts candida
2-Filamentous septate e.g.
Aspergillus
3-Filamentous non
septated e.g. Rhizopus

7. filamentous aspergillus

8. Risk factor
1.Trauma
2. Ocular surface disease
3. Topical steroid use
4. Location and Climate

9. Truma with vegetable matter

10. ● Pathophysiology
The infection probably starts when the
epithelial integrity is broken either due to:
1-trauma.
2- ocular surface disease .

11. ● Proteolytic enzymes, fungal antigens and toxins
are liberated into the cornea with the resulting
necrosis and damage to its architecture thus
compromising the eye integrity and function.

13. symptoms:
1 •Blurred vision
2• Red and painful eye that
does not improve when contact
lenses are removed
or on antibiotic treatment
3•Photophobia
4•Excessive tearing or discharge.
The symptoms are markedly less
as compared to a similar bacterial

15. Signs:
1 •The eyelids and adnexa involved shows edema
and redness
2•conjunctiva is chemosed.
•Ulcer may be present.
3•It is a dry looking corneal ulcer with satellite
lesions in the surrounding cornea.

16. conjunctiva is chemosed.

17. Usually associated with
fungal ulcer is hypopyon,
which is mostly white fluffy
in appearance.
(Note: Fungal endophthalmitis is extremely rare
Rarely, it may extend to the
posterior segment to cause
endophthalmitis in later stages,
leading to the destruction of the
eye.

18. Complications :
● Adverse results range from mild to severe
corneal scarring.
● corneal perforation.
● anterior segment disruption.
● glaucoma .
● endophthalmitis .
● evisceration.

19. Central Cornial scaring

20. Cornial perforation

21. Diagnosis:
Early diagnosis and treatment are of high degree of suspicion from physician ,
which are essential for a successful resolution of the fungal keratitis.
1-Corneal ulcers unresponsive to broad-spectrum antibiotics
2- the presence of satellite lesions
3-scanty secretions in a large ulcer are some signs that indicates the possibility of a
mycotic agent

22. Clinical diagnosis :
the slit lamp , in early evolution ,
the lesion might look like an unhealed
corneal abrasion with scanty infiltrates and
no secretions . With time the ulcer develops
thicker , infiltrates and unclear margins .
The presence of satellite lesions suggests
a fungal infection .
Redness and periocular edema are also
common .

23. Laboratory test
For a definitive diagnosis scrapings taken from deep into the lesion should be made and
inoculated in Sabouraud agar. The shortcoming is that it could take up to 3 weeks to grow
and identify the organism.

24. For a faster result, smears with special
stains such as Gomori, PAS, acridine
orange, calcofluor white or KOH should be
performed . If all labs are negative consider
a corneal biopsy

25. Differential diagnosis:
Fungal infections can mimic any microbial keratitis ,
1- Bacteria
2- Acanthamoeba related to swimming
3- Herpetic keratits
4- Retained foreign body , sterile infiltrates, and marginal ulcers due to
Staphylococcal hypersensitivity

26. Management
In general, management consist of medical
therapy with the use of topical and or
systemic anti-fungal medications alone or
in combination with surgical treatment.

27. Antifungal drugs:

28. Topical antifungals, either commercially available or
compounded from systemic preparation into eye-drops .
In resistant cases addition of systemic antifungal
have shown effectiveness.
If those fail
conjunctival flaps , lamellar or penetrating keratoplasty
might be needed.

29. Surgical:
● Corneal graft.
● Conjunctival
flap.

30. Prognosis :
● The aftermath of fungal keratitis can
be dismal . There is severe visual loss in
26% to 63% of patients. Fifteen to twenty
percent may need evisceration. Penetrating
keratoplasty was performed in 31 to 38%.

31. Thank you😇