𝘍𝘶𝘯𝘨𝘢𝘭 𝘜𝘭𝘤𝘦𝘳- 𝘋𝘪𝘢𝘨𝘯𝘰𝘴𝘪𝘴 𝘢𝘯𝘥 𝘔𝘢𝘯𝘢𝘨𝘦𝘮𝘦𝘯𝘵
The picture shows a KOH mount showing filamentous septate hyphae
𝗗𝗶𝗮𝗴𝗻𝗼𝘀𝗶𝘀:
● Corneal scraping- both diagnostic and therapeutic
● AC tap
● Corneal biopsy
● PCR
● Confocal microscopy
𝗦𝘁𝗮𝗶𝗻𝘀 𝘂𝘀𝗲𝗱:
● KOH mount with Calcoflour white
● Gram’s stain
● Giemsa stain
● Lactophenol cotton blue
● PAS stain
● Grocott’s Methenamine-silver stain
𝗙𝘂𝗻𝗴𝗮𝗹 𝗰𝘂𝗹𝘁𝘂𝗿𝗲:
● Sheep blood agar
● Chocolate agar
● Sabouraud dextrose agar (without cycloheximide) - should contain 50
micrograms /ml gentamicin and should be without cycloheximide as the latter inhibits saprophytic fungi.
● Thioglycollate broth - possible growth of anaerobic bacteria at 35 C to 37 C.
● Brain heart infusion
𝘈 𝘥𝘦𝘧𝘪𝘯𝘪𝘵𝘪𝘷𝘦 𝘥𝘪𝘢𝘨𝘯𝘰𝘴𝘪𝘴 𝘰𝘧 𝘧𝘶𝘯𝘨𝘢𝘭 𝘬𝘦𝘳𝘢𝘵𝘪𝘵𝘪𝘴 𝘪𝘴 𝘮𝘢𝘥𝘦 𝘪𝘧
1. Corneal scrapings reveal fungal elements in smears.
2. Fungus grows in more than one medium in the absence of fungus in smears.
3. Fungus grows on a single medium in the presence of fungus in smears.
4. Confluent growth of fungus appears at the inoculated site on a single solid
medium.
Initial growth occurs within 72 hours.
𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁:
𝗠𝗲𝗱𝗶𝗰𝗮𝗹:
● Topical antifungal agents
Natamycin 5% suspension – initial choice
Topical amphotericin 0.15% in cases of Candida/Aspergillus Fluconazole 0.3%/Miconazole/Voriconazole in cases of Fusarium
● Intracameral Amphotericin B- 5 ug in 0.1ml 5% dextrose
● Intrastromal therapy Amphotericin B 5-7.5 ug
● Subconjunctival injection in cases of scleritis
● Systemic antifungals (eg. Ketoconazole) given in:
Severe deep keratitis
Limbal involvement
Scleritis, Endophthalmitis
Prophylactic after TPK
Virulent fungus
● Cycloplegics
● Anti glaucoma drops if IOP is high
𝗦𝘂𝗿𝗴𝗶𝗰𝗮𝗹:
● Debridement- Debulks organisms & necrotic material and enhances penetration of topical antifungals. Every 24-48 hours.
● Biopsy
● Conjunctival flaps
● Therapeutic keratoplasty:
When progression is noted and involves limbus/sclera
Endophthalmitis
Impending perforations/frank perforations
No response to therapy
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