Mycotic Keratitis

Epidemiology: Mycotic keratitis was once very rare, occurring almost exclusively in farm laborers (see Etiology for contact with possible causative agents). However, this clinical syndrome has become far more prevalent today as a result of the increased and often unwarranted use of antibiotics and steroids.

Etiology: The most frequently encountered pathogens are Aspergillus and Candida albicans. The most frequent causative mechanism is an injury with fungus-infested organic materials such as a tree branch.

Symptoms: Patients usually have only slight symptoms.

Diagnostic considerations: The red eye is apparent upon inspection (normally the disorder is unilateral), as is a corneal ulcer with an undermined margin (Fig. 5.9). The ulcer will continue to expand beneath the visible margins (serpiginous corneal ulcer). Hypopyon may also be present (as shown in Fig. 5.9 a). Slit lamp examination will reveal typical whitish stromal infiltrates, especially with mycotic keratitis due to Candida albicans. The infiltrates and ulcer spread very slowly. Satellite lesions, several adjacent smaller infiltrates grouped around a larger center, are characteristic but will not necessarily be present.

Identification of the pathogen. Microbiological identification of fungi is difficult and can be time consuming (for histologic identification, see Fig. 5.9 b). It is important to obtain samples from beyond the visible margin of the ulcer. Fungal cultures should always be obtained where bacterial cultures are negative.

— Mycotic keratitis.

— Mycotic keratitis.

Fig. 5.9 a Clinical findings include a corneal ulcer that extends beyond the visible margin and hypopyon.

b Histologic findings include hyphae in the corneal stroma.

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