Mycotic(Fungal) Corneal Ulcer

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Mycotic(Fungal) Corneal Ulcer

MC mode of infection	Injury by vegetative material(crop leaf,thorn,wooden stick)
etiology	Aspergillus fumigatus(MC in india), Candida albicans, Fusarium
Symptoms	Same as bacteria but less severe
Signs (prominent) filamentous keratitis with fluffy edges – there is a large epithelial defect, and folds in Descemet membrane	yellowish white dry looking ulcer with elevated rolled out feathery & hyphate margins, Feathery fingerlike extensions, Satellite lesions are seen, Sterile immune ring(yellow line) of Wessely, Dense immobile Non sterile hypopyon(pseudo hypopyon), ring infiltrate, with satellite lesions and a hypopyon Perforation is rare, Vascularization absent
Hypopyon in fungal keratitis contain	Fungal filaments
staining	KOH Smear, Gomori's methenamine silver(GMS) stain
Wet KOH shows	Filamentous fungi(branched septate hyphae) - Aspergillus fumigatus,Fusarium, Non filamentous(yeast like) - Candida
culture	Salon agar, Brain heart infusion broath
Treatment	5% Natamycin eye drops(DOC) - filamentous fungi, Amphotericin B(DOC) - yeast lie fungi, Fluconazole - candida Itraconazole eye drops, Silver sulfadiazine used earlier, Systemic therapy for severe cases 1% Atropine ointment, Anti glaucoma drugs
Steroids are contraindicated in	Both bacterial & fungal ulcers
If contact lens wearers develop keratitis	Start antibiotic drops immediately, Discontinue lenses
For overwear syndrome	Avoid wearing contact lenses for 48-72 hours
MC fungus affect lids	Candida albicans