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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

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