- Rare, but should always be considered when history of trauma with
plant or vegetable matter is present or in an immuno-compromised patient.
- Etiology: Fusarium solani, Aspergillus sp., Curvularia sp., Candida
albicans, and rare Dimorphic fungi (Histoplasma, Sporothrix, etc.).
- Clinical features:
- Symptoms: foreign body sensation, decreased vision, ocular
pain, photophobia, red eye and watery discharge.
- Signs:
- Fine or coarse granular infiltrate within 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
- In advance cases: suppurative stromal keratitis associated
with conjunctival hyperemia, anterior chamber inflammation,
hypopion, iritis, endothelial plaque or possible corneal perforation.
- Work up:
- Corneal smears for yeasts, hyphae and pseudohyphae.
- Cytologic, histologic examination, culture and corneal biopsy
for diagnosis, confirmation and treatment purposes.
- Management:
- Prolonged course of systemic and topical antifungal.
- Frequent scraping or localized debridement to remove superficial
corneal necrotic tissue.
- Cycloplegic drop is indicated to reduce intraocular inflammation,
relieve ciliary spasm and prevent posterior synechiae.
- Anti-inflammatory agents and corticosteroids.
- Surgical procedures such as superficial, lamellar keratectomy
or penetrating keratoplasty are indicated when optimal anti-fungal
therapy has failed to cure this infection.
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