Mycotic Corneal Ulcer

MYCOTIC CORNEAL ULCER


MYCOTIC CORNEAL ULCER

  • The incidence of corneal ulceration due to fungi has increased significantly due to long-term unwarranted use of antibiotic & steroid.
  • The m/c mode of infection is injury by vegetative material such as crop leaf, thorn, wooden stick.
  • The causative fungus are Aspergillus fumigates (most common), Candida albicans & fusarium.

Clinical features

  • Symptoms are similar to bacterial corneal ulcer.
  • In general they are less marked than the equal sized bacterial ulcer.
  • Signs are very prominent i.e signs are more prominent than symptoms.
  • Following signs can be seen:
  1. Grayish-white dry looking ulcer with the elevated rolled out feathery & hyphate margins.
  2. Feathery finger-like extension into surrounding stroma under intact epithelium.
  3. A sterile immune ring (yellow line) of Wesseley.
  4. Multiple small satellite lesions
  5. Non –sterile (infected) hypopyon (Pseudohypopyon)
  6. Perforation is rare & corneal vascularisation is conspicuously absent

Diagnosis

  • Examination of wet KOH will show:
  1. Filamentous fungi (branched septate hyphae): Aspergillus fumigates, Fusarium
  2. Non-filamentous (yeast like fungi): Candida

Treatment

  • Treatment of corneal fungal ulcer involves:

1. SPECIFIC (DEFINITIVE): Includes antifungal drugs.

A) Topical antifungals

i) For filamentous fungi (Aspergillus fusarium):

  • Natamycin (5%) eye drops (drug of choice)
  • Miconazole ointment
  • Amphoterecin B drops

ii) For yeast (Candida):

  • Amphhoterecin B (Drug of choice)
  • Nystatin

B) Systemic antifungals

  • May be required in severe cases.
  • Fluconazole or ketoconazole may be used

2. ADJUNCTIVE/ CONCURRENT:

  • Cycloplegics (1% atropine ointment or drop is the DOC) should be used to:
  1. Reduce pain from ciliary spasm
  2. Prevent posterior synaechiae
  3. Reduce uveal inflammation
  • Topical steroids enhance fungal replication  & corneal invasion & are contraindicated during early therapy of a fungal corneal ulcer.

Exam Important

  • Features of fungal ulcer is Dry ulcer.
  • Hypopyon in a fungal corneal ulcer contains Fungal filaments.
  • Common fungus causing corneal ulcer is Aspergillus fumigates, Candida albicans & fusarium.
  • Immune ring is a feature of Fungal corneal ulcer.
  • Satellite lesions in the cornea may be seen in Fungal corneal ulcer.
  • Natamycin is the drug of choice for treatment of corneal ulcers caused by filamentous fungi.
  • Atropine sulphate eye ointment is the most important adjuvant therapy in a case of fungal corneal ulcer.
  • Steroid is contraindicated in Fungal corneal ulcer.

 

Don’t Forget to Solve all the previous Year Question asked on MYCOTIC (FUNGAL) CORNEAL ULCER

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