Fungal Keratitis

Clinical Description

Corneal inflammation caused by fungal infection

Signs and Symptoms

• Painful red eyes, Photophobia, blurred vision, mucopurulent discharge
• Circumlimbal injection, corneal infiltrates with feathery margins
• May complicate to endophthalmitis (independent hypopyon)

Investigations

Corneal scrapings (microscopy, culture, sensitivity)

Treatment

• Epithelial debridement over the lesion enhances penetration of antifungal agents.
• Topical treatment initially hourly for 48 hours and then reducing as signs permit.
• Use topical Natamycin 5% gutt or Econazole 1% gutt, Amphotericin B 0.15%, Miconazole gutt 1% or Voriconazole 1 or 2% for either filamentous or candida infections.
• Subconjunctival Fluconazole may be used in severe cases with hypopyon.
• Systemic anti-fungals may be required for severe keratitis or endophthalmitis such as Fluconazole 200mg twice daily for a week or Voriconazole 400 mg twice daily for one day then 200 mg twice daily, Itraconazole 200 mg once daily, reduced to 100 mg once daily.
• Cycloplegics (Atropine 1% gutt every 12hrs or Cyclopentolate 1% gutt EVERY 8HRS.
• Ciprofloxacin eye drops 0.3% EVERY 6HRS should also be used as bacterial co- infection is common