Overview
Fungal keratitis is an infection of the cornea caused by fungi, often complicating ocular trauma, chronic steroid use, and compromised ocular surfaces. It can lead to significant visual impairment and requires prompt diagnosis and treatment to prevent severe outcomes such as perforation and corneal grafting 123.Diagnosis
Clinical Presentation: Corneal ulceration with characteristics such as feathery margins, ring infiltrate, and satellite lesions 23.
Microbiological Testing: Corneal scrapings and tear samples analyzed via culture and molecular techniques (e.g., real-time PCR targeting ITS) 1.
Risk Factors: Ocular trauma, chronic steroid use, poor ocular surface health, HIV seropositivity, and chronic ocular surface disease 23.Management
First-Line Treatment: Antifungal agents, with Candida albicans often treated using agents like natamycin or voriconazole 23.
Adjunctive Therapy: Corneal collagen crosslinking (CXL) as an adjuvant to standard antifungal therapy shows promise in reducing healing time and improving visual acuity 1.Special Populations
HIV Seropositivity: Higher incidence noted in patients with HIV, requiring vigilant monitoring and tailored antifungal therapy 3.
Chronic Ocular Surface Disease: Increased susceptibility; management should focus on both infection control and underlying surface health 3.Key Recommendations
Incorporate corneal collagen crosslinking as an adjuvant therapy to standard antifungal treatment for enhanced resolution and visual outcomes in fungal keratitis (Evidence: Moderate) 1.
Prioritize microbiological confirmation through corneal scrapings and molecular diagnostics to guide targeted antifungal therapy (Evidence: Moderate) 12.
Consider the presence of HIV and chronic ocular surface disease as significant risk factors influencing treatment strategies and prognosis (Evidence: Moderate) 23.References
1 Jeyalatha Mani V, Parthasarathy D, Padmanabhan P, Narayanan N, Lakshmipathy M, Pachayappan SK et al.. Therapeutic Effect of Corneal Crosslinking on Fungal Keratitis: Efficacy of Corneal Collagen Crosslinking as an Adjuvant Therapy for Fungal Keratitis in a Tertiary Eye Hospital in South India. Ocular immunology and inflammation 2021. link
2 Bhartiya P, Daniell M, Constantinou M, Islam FM, Taylor HR. Fungal keratitis in Melbourne. Clinical & experimental ophthalmology 2007. link
3 Ritterband DC, Seedor JA, Shah MK, Koplin RS, McCormick SA. Fungal keratitis at the new york eye and ear infirmary. Cornea 2006. link