Mycotic keratitis

Etiopathogenesis and Clinical features

1. MYCOTIC CORNEAL ULCER/ FUNGAL CORNEAL ULCER/ MYCOTIC OR FUNGAL KERATITIS/ KERATOMYCOSIS by : tabassum sultana Dr.VRK WOMEN”S MEDICAL COLLEGE

2. MYCOTIC KERATITIS ETIOPATHOGENESIS CLINICAL FEATURES

3. CAUSATIVE ORGANISMS

4. RISK FACTORS Trauma to Corneal epithelium Underlying Corneal diseases Indiscriminate use of Steroids Immunocompromised subjects Dry Eyes Chronic Dacrocystitis or Blepharitis Lowering of general body resistance

5. MODE OF INFECTION 1)Ocular trauma 2)Secondary fungal ulcers 1)Injury by vegetable matter : wood stick, thorn etc. 2)Injury by animal tail. 3)Secondary fungal ulcers are common in immunocompromised

6. PATHOGENESIS Defect in corneal epithelium Fungi enter into corneal stroma Multiplication of fungi Tissue necrosis & inflammatory reaction Purulent infiltrate Saucer shaped ulcer,odematous edges and surrounding grey zone of infiltration

7. Break through descement membrane, toxins enter anterior chamber Irritation of vessels of iris and ciliary body keratouveitis Leucocytosis occurs , PMNs poured out by vessels, gravitate to bottom of anterior chamber ----- HYPOPYON Vascularization develops near ulcer to restore loss of substance & also supplies antibodies

8. Line of demarcation forms Leucocytes macerate & dissolve necrotic tissue Infiltration & swelling disappear , floor and edges become smooth and transparent Healing process continues Cicatrization and formation of corneal scar

9. CLINICAL FEATURES Mycotic keratitis is frequently seen in field workers, rural areas, tropical countries and in immunocompromised individuals . In Mycotic keratitis Symptoms are less prominent Signs are more marked

10. SYMPTOMS Decreased vision, Pain, Redness, Lacrimation , Photophobia, Foreign body sensation Visible Whiteness of cornea

11. Fungal corneal ulcer

12. - Greyish White lesion, -Dry & Rough texture, -Elevated rolled out margins, -delicate, Feathery border

13. WESSELEY / IMMUNE RING

14. SATELLITE LESIONS

15. Fungal keratitis -filamentous fungi

16. Fungal keratitis candida

17. fungal keratitis - convex hypopyon

18. HYPOPYON FUNGAL KERATITIS BACTERIAL KERATITIS Massive Thick Immobile Unsterile Small Fluid Mobile Sterile

19. HYPOPYON WITH SHIFTING FLUID LEVEL ON TILTING THE HEAD IN BACTERIAL CORNEAL ULCER