(a) Aspergillosis (Aspergillus) (Filamentous Fungus, Septate Hyphae)3
Notes: 1. Dacryocystitis: Surgical removal of 'aspergilloma' with possible surgical reconstruction of nasolacrimal drainage system is the definitive treatment. Antifungal medication is not generally required.
2. Keratitis1: First choice is topical amphotericin B drops Qlhr initially with oral voriconazole, ketoconazole or fluconazole; Second choice topical agent is voriconazole or natamycin. Consider miconazole drops for infections refractory to amphotericin B, voriconazole, and natamycin.
3. Endophthalmitis3: Intravitreal and subconjunctival amphotericin B with vitrectomy. Should evaluate for systemic involvement.
4. Orbital infection3: Requires surgical debridement with intravenous amphotericin B.
(b) Fusarium (Filamentous Fungus, Septate Hyphae)
Notes: 1. Keratitis1: First choice topical agent is natamycin every 30min to Ihr for first two days; second line topical agents are voriconazole, miconazole, or flucytosine.
(c) Mucormycosis3 (Zygomycosis) (Filamentous Fungus, Nonseptate Hyphae)
Notes: 1. Keratitis1 /Endophthalmitis^: Due to the highly invasive nature, would recommend local treatment with topical amphotericin B and systemic amphotericin B. Consider surgical debridement.
2. Orbital infection3: Use intravenous amphotericin B; may require surgical debridement with topical amphotericin B washings.
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