Introduction  

Keratitis is an inflammation or infection of the outer covering of the eyeball, the cornea. An infection by a fungal organism can cause an inflammation of the cornea. This kind of corneal infection is referred to as fungal keratitis. 

An eye injury or use of contact lens can lead to fungal keratitis. The infection develops very fast and may lead to ulceration as the fungus feeds on the corneal tissues. It is an eye disease that can cause severe loss of vision and blindness.

This eye disease can be caused by many species of fungi that can colonize human tissue. Some of the fungi that can cause an inflammation of the cornea include: 

  • Aspergillus species
  • Candida species
  • Fusarium species

Although a sporadic eye disorder, fungal keratitis can become a severe eye condition with devastating visual results.

Also Known As

 

Sub-Types

 

Causes and Risk Factors

In most cases, fungal keratitis occurs after the individual experiences trauma to the eye. An eye Injury caused by plant material such as a branch, stick or thorn is the most common.

Fusaria are a fungi family that thrive in water, soil and plants all over the globe. This particular species is abundant in warmer climates. Therefore, in the more temperate regions, any injury to the cornea caused by plant material can lead to fungal keratitis. 

People with weak immune systems may also contract fungal keratitis when they are exposed to the fungi. 

Risks factors:

  • An underlying eye disease
  • Use of contact lens 
  • A recent eye injury, especially involving plant matter
  • Certain contact lens solutions
  • Chronic keratitis
  • Use of topical corticosteroid
  • Refractive or penetrating eye surgery
     

Signs & Symptoms

It may not be easy to differentiate between fungal and bacterial keratitis. Some distinctive characteristics of fungal keratitis are suggestive. They include:

  • Satellite infiltrating substances
  • Elevation of the corneal surface with a gritty, rough texture 
  • Gray-white, dry looking infiltrating substance
  • Epithelium might be intact over a deep stromal infiltrate
  • Feathery  or irregular infiltrate edge

Symptoms of fungal keratitis include:

  • Excessive tearing
  • Severe eye pain
  • Eye redness
  • Eye discharge
  • Blurred vision
  • Increased sensitivity to light

A person who experiences any of these symptoms should call an eye doctor or visit a health facility right away. It is especially critical when the symptoms appear all over a sudden. If the individual wears contact lens, they should remove them.
 

Diagnosis

The eye care professional takes the patient’s medical history and examines the eye. He/she may take a scrapping of the cornea as a sample for laboratory analysis.  The professional may also perform the following tests for a proper diagnosis of the condition:

  • Slit lamp examination 
  • Visual acuity test 
  • Dilated fundus exam 
  • Motility test 
  • Intraocular pressure exam
  • External and anterior segment examination
     

Treatment 

Treatment is focused on tackling the fungus and preventing loss of vision.

Medical Treatment

A person with fungal keratitis must start treatment immediately. Otherwise, there is an irreversible loss of sight and even blindness.

The eye doctor may prescribe antifungal medicines, including oral medication and eye drops, for several months. Often, topical antifungal drops are the main drugs used in the treatment of fungal keratitis.

Surgical Treatment

Where skin treatment and antifungal medications are not effective, the patient might need surgery to restore vision and prevent blindness. 

In severe cases, surgical treatment may include corneal transplantation.

In extremely severe cases, even surgery may be unable to restore vision. It means the patient may experience permanent vision impairment or even complete blindness.

Prognosis/Long-term outlook

Fungal keratitis is an eye disease with potentially catastrophic visual outcomes. That is why it is so critical for an individual to visit an eye doctor at the earliest sign of an eye infection.

Patients should also follow up with the doctor to check how they are responding to treatment.

Prevention/Follow Up

People who are undertaking hazardous tasks such as trimming grass, chopping wood, grinding metal and curving stone should wear safety glasses. These protect the eye from flying pieces of debris that can lead to an eye injury and fungal keratitis.
 
Using protective eyewear is also crucial for sport and other outdoor activities. 

People who wear contacts should respect the lens care regimen at all times.

Maintaining good hygiene is vital at both personal and environmental levels. One must take care to wash hands before handling contact lenses. One should also use a clean and dry towel to dry hands after washing.