Fungal Keratitis

Fungal keratitis (mycotic keratitis/keratomycosis) is hard to diagnose, easily misdiagnosed, often causes blindness. Predisposing: corneal trauma (main), ocular surface disease, contact lenses, long-term antibiotics/steroids. Not rare.

Common Symptoms

Bacterial infection; fungal infection; tarsal conjunctival injection; corneal ulcer; conjunctival edema/corneal ulcer; corneal burn/abrasion

Causes and Pathogenesis

Normal cornea resistant; trauma/surgery/long antibiotics/steroids/immunosuppression/dry eye converts non-pathogenic fungi to pathogens. Common: Aspergillus, then Fusarium/Candida/Acremonium/Streptomyces. Routes: exogenous (plant/soil trauma), spread from adnexal infection, endogenous hematogenous. 27% normal conjunctival sacs culture fungi. Risk factors: plant trauma (grain); topical steroids (point erosions, fungal overgrowth, immune depression); broad-spectrum antibiotics (flora shift); contact lenses (erosion/contaminated solution); systemic anticancer/immunosuppressive. Pathogenesis: fungal adhesion to epithelium → enzyme secretion (phospholipases/metalloproteinases) → invasion. Growth patterns: (1) horizontal carpet-like superficial → good antifungal response, high scraping yield, lamellar keratoplasty candidate; (2) focal laminar vertical/horizontal → deep stromal ulcer with satellites/pseudopodia, poor antifungal response, contraindication to lamellar transplant, PKP with 0.5 mm margin; (3) full-thickness chaotic vertical growth, severe inflammation, hypopyon.

Treatment

Drug therapy, supportive therapy

Preventive Measures

Avoid corneal trauma; no antibiotic/steroid abuse; monitor long-term steroid users.

Department to Visit

It is recommended to visit the Ophthalmology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.