Cornea

Question 1

Filamentous (fusiform, aspergillus)

Answer 1

Multicellular
hyphae
Tropical climates

Question 2

Cf of fungal keratitis

Answer 2

• Grey or yellow-white stromal infiltrates
• ring-shaped infiltrate
• progressive infiltration
• indistinct fluffy margin
• satellite lesions
• Endothelial plaques

Epi defect(-)        if (+)—>small 
AU, hypopyon, |IOP, scleritis, 
Endophthalmitis without evidence of perforation (d/t penetration of intact DM)

Question 3

Investigation of fungal

Answer 3

1. Staining (KOH, Gram, Giemsa, PAS, GMS, Calcoflour white stain)
2. Culture
   
   • sabourad dextrose agar(most fungi)
   • blood agar(fusarium)
3. Corneal biopsy
   I’ - no clinical improvement a/f 3-4 days
   - no growth from scraping a/f 1 wk
4. AC tap
5. Confocal microscopy
6. PCR for fungal DNA

Question 4

Treatment outlines of fungal

Answer 4

1. General measure
2. Removal of epithelium
3. Medical Tx
4. Surgical Tx

Question 5

Medical Tx of fungal k

1. Topical antifungal
2. Broad spectrum topical antibiotic
3. Cycloplegic
4. Subconjunctival fluconazole
5. Systemic antifungal in severe case

Answer 5

Topical antifungal- hourly 48 hr then reduced, continue 3 mth d/t fungistatic

Filamentous

1. Nata 5%
2. Econazole 1%
3. Ampho B 0.15%
4. Miconazole 1%
5. Voriconazole 1%