Fungal eye-disease

topic of ZOLOGY

1. FUNGUS EYE DISEASE
• Blepharitis
• Keratitis
• POHS
• Endophthalmitis
• Orbital disease

2. Fungal Blepharitis
Rare
1.Dermatophytes
2.Candida
Poorly controlled DM

3. Fungal Keratitis
1.Fusarium (65%- tropics)
2.Candida (12.5%)
3.Curvularia (9%)
4.Aspergillus (4%- temperate)
A) Filamentous Keratitis (Asp., Fusarium)
TRAUMA by organic matter (wood)/ Rural
No preexisting eye disease or immunosupression
Grayish-white ulcer (indistinct, elevated margins)
Feathery stromal infiltrates/ ring infiltrate
Satellite lesions/ hypopyon

4. B) Candida Keratitis
• Chronic eye disease
• Immunocompromised
Yellow-white ulcer
Dense suppuration
Management:
• Reculture/ deep scrapings/ corneal biopsy
• Exclude fungal dacryocystitis
• Debridement (daily for 1/52)
• Topical LONG 6/52 min (Natamycin- imidazole)
• Systemic (sleral involvement)/ itrakonazole
• PRK (25%)

5. POHS
Histoplasma capsulatum/ Airborne
Missisipi- Misouri river valleys (5-10%)
• Majority : asymptomatic fungaemia (URTI)
• Small minority: severe, disseminated (endophthalmitis)/
immunocompromised
• POHS
Investigations:
Skin test: 90% ve +
XR: calcification (lung, liver, spleen)
HLA -B7 (maculopathy)

6. Symptoms/ Signs:
Asymptomatic unless maculopathy (metamorphopsia)
1.Atrophic histo-spots (immunologic reaction)
2.PPA
3.Peripheral linear streaks (chorioretinal atrophy)
4.CNV (20-45y)/ 5-10%
5.NO Vit. involvement
Daily Amsler chart fellow eye if unilat. maculopathy with
asymptomatic histospot in fellow eye
Rx: Argon laser after FFA

7. Endophthalmitis
A) Fusarium/ Asp.: rapid visual loss
Exogenous: surgery, trauma, keratitis
B) C. albicans/ opportunistic: Slow progression/ well tolerated
Endogenous:
1.Drug addicts (SKIN)
2.Catheters (iv hyperalimentation)
3.Immunocompromised

8. Choroidal focus® retinal invasion (Roth spots)® vitreous
(cotton ball) ® string of pearls ® endophthalmitis (retinal
necrosis) ® vit. organisation (traction RD)
Rx: 5 FC+ Ketokonazole (3/52)
iv amphotericin
TPPV + intravit amphot
30% candidemia: candidiasis
80% candidiasis: chorioretinitis
85% endogenous endophth.: disseminated candidiasis

9. Fungal endophthalmitis following cataract
surgery
• Rare (Western World- late presentation)
• Cluster infections (within 4/52)
• Developing countries (20%-India, isolated, early diffuse
presentation)
• Aspergilus flavus
• Rx: TPPV+ antifungal agents
• Visual outcome: corneal involvement
• NO STEROIDS

10. Orbital Disease
Aspergillus species
Immunocompetent host (usually)
Immunosupressed (sinoorbital aspergillosis)
1.Allergic fungal sinusitis (non-invasive/ children)
2.Invasive fungal sinusitis (tropics, Sudan)
Slow, painless extension from sinuses to orbit and brain (months)
High mortality: 80%
Rx: surgery+ antifungal agents

11. MUCORMYCOSIS
Opportunistic phycomycetes (Mucorales)
1.DK
2.MA/ uremia
3.Severe immunosuppression
4.Desferrioxamine
Vascular occlusion- infarction- necrosis
Sinusitis, pharyngitis, nasal discharge
Multiple cranial nerve palsies
CRAO
Eschar (periorbital,nose, hard palate) LATE

12. Rx: PROMPT and AGGRESSIVE
• Metabolic deficit
• Surgical
• Amphotericin B (iv, locally)
• Hyperbaric oxygen