Fungal Keratitis

1. Fungal Keratitis Dr. Soujanya K MBBS, MS (Ophthal), DNB, FPRS Assistant Professor YMCH

2. Etiology • i. Filamentous fungi : • Aspergillus (most common), Fusarium, Alternaria, Cephalosporium, Curvulariaand Penicillium. • ii. Yeasts: Candida and Cryptococcus.

3. Modes of infection

5. Modes of infection • i. Injury by vegetative material • ii. Injury by animal • iii. Patients who are immunosuppressedsystemically or locally

6. Clinical features • Symptoms : • are similar to the central bacterial corneal ulcer • less marked than the equal-sized bacterial ulcer • overall course is slow and torpid.

7. Symptoms Bacterial Fungal

8. Signs • Dryin appearance. • Feathery borders • An immune ring (Wesseley) : deposition of immune complexes and inflammatory cells around the ulcer. • Satellitelesions. • Hypopyon : thick and immobile, and is due to direct invasion into the anterior chamber of fungal hyphae enmeshed in thick exudates. • There is marked ciliaryand conjunctival congestion,

11. BacteralKeratitis Fungal Keratitis Symptoms are less Dry appearing, feathery margin May be present May be present Contains fungal hyphae, thick • Symptoms are more ( Pain, lid edema) • Round or oval ulcer in central part of cornea • Satelite lesions : Absent • Immune ring: Absent • Hypopyon : Sterile, mobile

12. Laboratory investigations • Wet KOH, • Calcofluor white, • Gram's and Giemsa- stained films for fungal hyphae and • Culture on Sabouraud's agar medium.

15. Treatment • 1. Topical antifungal eye drops should be used for a long period (6 to 8 weeks): • Natamycin (5%) eye drops • Fluconazole(0.2%) eye drops • Nystatin (3.5%) eye ointment.

16. 2.Systemic antifungal drugs may be required for severe cases of fungal keratitis. • Tablet fluconazoleor ketoconazole may be given for 2-3 weeks.

17. Viral keratitis

18. Herpes simplex • Herpes zoster

19. Herpes simplex

20. HSV 1 HSV 2

23. Clinical reactivation • A variety of stressors such as • fever, • hormonal change, • ultraviolet radiation, • trauma

24. Herpes simplex – ocular manifestations • Blepharitis, • Conjunctivitis, • Keratitis • Iridocyclitis

25. Primary infection • No previous viral exposure, • Childhood • Subclinical or mild prodromal symptoms. • Blepharitis and follicular conjunctivitis :mild and self-limited. • Treatment: topical aciclovir ointment for the eye and/or cream for skin lesions.

26. Superficial Punctatekeratitis— • numerous minute whitish plaques , arranged in rows or groups. • Desquamate erosions heal rapidly leaving no opacity • Cornea: relatively insensitive.

27. The corneal involvement can be • Epithelial(dendritic or geographic keratitis), • Stromal(necrotizing and non-necrotizing stromalkeratitis) and • Endothelial

28. Dendriticulcers Pathognomonic of HSV keratitis

34. Floor of the ulcer stains with fluorescein and the virus-laden cells at the margin take up rose bengal.

35. fluorescein rose bengal

36. Corneal sensations – markedly reduced

37. Geographical ulcer

39. Branches of dendritic ulcer enlarge Steroid use Coalesce to form a large epithelial ulcer ( 'geographical' or 'amoeboid' configuration.)

40. Branches of dendritic ulcer enlarge Steroid use Coalesce to form a large epithelial ulcer ( 'geographical' or 'amoeboid' configuration.)

41. Branches of dendritic ulcer enlarge Steroid use Coalesce to form a large epithelial ulcer ( 'geographical' or 'amoeboid' configuration.)

42. Geographical ulcer

43. Specific treatment • 1. Antiviral drugs are the first choice presently. • Aciclovir • Ganciclovir • Triflurothymidine • Vidarabine

44. 2. Mechanical debridement : helps by removing the virus-laden cells.

45. Disciformkeratitis

46. Pathogenesis HSV

47. Hypersensitivity reaction

48. Low grade stromal inflammation and damage to the underlying endothelium Corneal oedema Disciformkeratitis

49. Signs