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Aspergilus sp. Fungal Keratitis

  • 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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