Question

Describe the clinical features of each and management of fungal corneal ulcer.

Hint:

Fungal corneal ulcers require aggressive treatment with antifungal therapy, debridement, and long-term follow-up to prevent complications like scarring or blindness.

Answer 1

Fungal corneal ulcers are infections caused by fungal organisms, with Aspergillus, Fusarium, and Candida being the most common pathogens. These ulcers present with specific clinical features and require targeted management.

Step 1: Clinical Features of Fungal Corneal Ulcer:
1. Pain and Redness: Patients with fungal corneal ulcers often experience intense eye pain, redness, and discomfort, especially when exposed to light (photophobia).
2. Blurred Vision: Vision is typically impaired due to the presence of the ulcer on the corneal surface, leading to a decrease in visual acuity.
3. Corneal Appearance: The ulcer typically appears as a white, grayish, or yellow lesion on the cornea with irregular, raised borders. A satellite lesion or "ring infiltrate" is often seen around the ulcer.
4. Discharge: The discharge from the infected eye may be mucopurulent, thick, and sticky, which distinguishes it from other types of eye infections.
5. Slow Progression: Unlike bacterial ulcers, fungal infections tend to progress more slowly and may not present with the acute symptoms seen in bacterial infections.

Step 2: Management of Fungal Corneal Ulcer:
1. Topical Antifungal Treatment: The first-line treatment for fungal corneal ulcers is the application of topical antifungal medications such as Natamycin, Amphotericin B, or Voriconazole. These drugs help inhibit fungal growth and control infection.
2. Systemic Antifungal Therapy: For deeper or more severe fungal infections, oral antifungal agents like Fluconazole or Itraconazole may be prescribed to enhance the effect of the topical treatment.
3. Corneal Debridement: In cases of deep or persistent fungal ulcers, corneal debridement may be necessary to remove necrotic tissue and promote healing.
4. Corneal Transplantation: If the fungal ulcer causes significant scarring or damage to the cornea, a corneal transplant may be required to restore vision.
5. Supportive Care: Pain management, such as topical analgesics, and regular follow-up visits are essential to monitor the progress of healing and prevent complications such as corneal perforation.