Fungal keratitis

Fungal keratitis develops rarely, they are caused by mold, radiant and yeast fungi.

Infection occurs after minor damage to the cornea, more often in rural areas. It is possible to transfer fungi from the foci to the eye. The first symptoms appear quickly - already on the 2-3rd day after the injury. The inflammatory focus is more often localized in the surface layers.

In the deep layers, fungi can penetrate with the wounding object. If the foreign body remains in the cornea for a long period of time, a creeping ulcer can develop with all its symptoms and consequences.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Symptoms of fungal keratitis

Symptoms of fungal lesions of the cornea have characteristic features. Already on the basis of the appearance of the infiltrate, one can assume the fungal nature of the disease. Subjective symptoms and pericorneal injection of vessels are poorly expressed in the presence of a rather large lesion in the cornea. The white or yellowish color of the focus of inflammation, which has clear boundaries, is characteristic. Its surface is dry, the infiltration zone is similar to a salt incrustation, sometimes it is tuberous or curdled, as if it consists of grains and slightly protrudes over the surface of the cornea. The hearth is usually surrounded by a restrictive infiltration roller. The clinical picture can be as if frozen for a few days or even 1-2 weeks. However, the changes are gradually increasing. The infiltration roller around the focus begins to break down, the corneal tissue is necrotic. At this time, the entire white dry-looking hearth can separate itself or is easily removed by the scraper. Under it opens a depression that slowly epithelizes, and is subsequently replaced by a thorn. For fungal keratitis is characterized by the absence of neovascularization. Creeping ulcers of a fungal nature are usually combined with a hypopion. Perforation of the cornea is also possible with the formation of coarse whiteness, fused with the iris, although this is not characteristic of fungal keratitis. In the material obtained from the focus of inflammation, a microscopic examination reveals a dense weave of filaments of the mold or drusen of the radiant fungus.

Diagnosis of fungal keratitis

Despite the fact that in typical cases the clinical picture of fungal keratitis has quite noticeable features, reliable etiologic diagnosis is not always simple, since along with characteristic there are other manifestations of fungal keratitis. In addition, fungi can complicate the course of bacterial keratitis in the necrotic stage of inflammation. They multiply well in tissues in which oxidative processes are poorly expressed. In this regard, with all torpid keratitides, it is necessary to study necrotic material for the presence of fungi. If suspected of fungal keratitis, steroids are not used, as they activate the growth of fungi. The curative central region in the focus of inflammation is removed by the scraper, the bottom and edges are cleaned with a sharp spoon, then extinguish with 5% alcohol solution of iodine. The removed material is subjected to examination.

[13], [14], [15], [16]

Treatment of fungal keratitis

In the treatment of fungal keratitis, intraconazole or ketoconazole, nystatin or other drugs are prescribed inside, to which the specific type of fungi is sensitive. Locally, instillations of amphotericin, nystatin, sulfadimizine and actinolysate (with actinomycosis) are used. Intraconazole is prescribed 200 mg orally once a day for 21 days. To prevent the development of a collateral infection, sulfonamides are used in drops, eye ointments with antibiotics. With a long persistent current of fungal keratitis with the location of the inflammation focus in the central part of the cornea, curative layered keratoplasty is shown.