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.