It’s a fungus!
Fungal ulcer is caused by organisms:
● Nonpigmented Filamentous septate: Fusarium, Aspergillus
● Pigmented Filamentous septate: Alternaria, Curvularia
● Filamentous Non-septate: Mucor
● Yeasts: Candida
R𝘪𝘴𝘬 𝘍𝘢𝘤𝘵𝘰𝘳𝘴:
𝗢𝗰𝘂𝗹𝗮𝗿 𝗳𝗮𝗰𝘁𝗼𝗿𝘀:
● Trauma (with vegetative or organic matter)
● Chronic corneal inflammation - due to vernal or allergic keratoconjunc tivitis and neurotrophic ulcers secondary to varicella zoster or herpes simplex viruses ocular surface disorders, dry eye, Steven Johnson syndrome and bullous keratopathy.
● Contact lens wear
● Drugs – Corticosteroids, Anaesthetics
● Corneal surgery – PKP, Refractive surgery
𝗦𝘆𝘀𝘁𝗲𝗺𝗶𝗰 𝗳𝗮𝗰𝘁𝗼𝗿𝘀:
● Diabetes
● HIV positive patients
● Leprosy
𝗣𝗮𝘁𝗵𝗼𝗴𝗲𝗻𝗲𝘀𝗶𝘀:
● Fungi are a part of the normal microbial environment and in the absence of a precipitating event, rarely cause infection in the cornea.
● Defect in epithelium (due to external trauma, compromised ocular surface, previous surgery) → Access to corneal stroma → Proliferate → Tissue necrosis and host inflammatory response → Penetrate deeper in stroma even through intact Descemet’s membrane → Access into anterior chamber/iris makes eradication difficult.
● Blood-borne growth inhibiting factors may not reach the avascular tissue such as the cornea, anterior chamber and sclera, and hence the fungi continue to multiply and persist despite treatment.
𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘧𝘦𝘢𝘵𝘶𝘳𝘦𝘴:
𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀:
● Foreign body sensation
● Gradually increasing pain
● Diminished vision
𝗦𝗽𝗲𝗰𝗶𝗳𝗶𝗰 𝘀𝗶𝗴𝗻𝘀:
● Grayish white or yellowish white infiltrate
● Irregular Feathery margins
● Elevated edges
● Dry rough texture
● Hyphate (branching) ulcers
● Satellite lesions
● Endothelial plaques
● Base of the ulcer- Soft, creamy and raised exudates
● Yellow line of demarcation
● Immune ring of Wesseley
● Fixed hypopyon- Non, sterile, thick and immobile
𝘋𝘦𝘮𝘢𝘵𝘪𝘢𝘤𝘦𝘰𝘶𝘴 𝘧𝘶𝘯𝘨𝘪: Gray/brown pigmentation - alteration in the melanin metabolism - indicates a more superficial infection, low virulence of the organism and less inflammatory reaction.
Dx & Rx - next post
Image from Rajan Eye Care Hospital
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