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What Is Fungal Keratitis?

Fungal keratitis is a corneal infection caused by filamentous fungi or yeasts, such as Fusarium, Aspergillus, or Candida. These organisms invade the corneal stroma and set off inflammation and tissue damage. It often follows trauma with plant material or occurs in contact lens wearers, especially in warm, humid climates. Symptoms can be similar to bacterial keratitis but often progress more slowly. Delayed diagnosis increases the chance of scarring, perforation, and permanent vision loss.

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What Is Fungal Keratitis?

Fungal keratitis is a corneal infection caused by filamentous fungi or yeasts, such as Fusarium, Aspergillus, or Candida. These organisms invade the corneal stroma and set off inflammation and tissue damage. It often follows trauma with plant material or occurs in contact lens wearers, especially in warm, humid climates. Symptoms can be similar to bacterial keratitis but often progress more slowly. Delayed diagnosis increases the chance of scarring, perforation, and permanent vision loss.

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Causes and Risk Factors for Fungal Keratitis

Corneal injury with organic matter, such as tree branches, crop fragments, or soil, is a classic trigger for filamentous fungal infection. Poor contact lens hygiene, contaminated solutions, and extended wear lenses are major risk factors in urban settings. Prior topical steroid use, chronic ocular surface disease, and systemic immunosuppression also raise risk. Yeast infections such as Candida are more common in eyes with prior surgery, surface disease, or severe dry eye.

Symptoms and Clinical Features

Patients usually present with eye pain, redness, tearing, and blurred vision. Photophobia is common, and symptoms often evolve over days to weeks. On slit lamp exam, fungal ulcers may show feathery borders, raised slough, satellite lesions, and a dry looking surface. In deep disease, there can be stromal infiltrates that extend toward the endothelium, hypopyon, and endothelial plaques. The appearance can overlap with other keratitides, so clinical pattern plus history raises suspicion.

How Is Fungal Keratitis Diagnosed?

Diagnosis depends on microbiologic testing. The eye doctor performs corneal scrapings and sends material for direct microscopy with KOH or special fungal stains and for culture on appropriate media. In vivo confocal microscopy can help visualize fungal filaments in the stroma. The clinician reviews history for plant trauma, contact lens wear, and steroid exposure. Distinguishing fungal from bacterial or acanthamoeba infection is critical because treatment regimens differ.

How Is Fungal Keratitis Treated?

Treatment centers on intensive topical antifungal therapy tailored to organism type and drug sensitivity. Natamycin is often used for filamentous fungi, while amphotericin B or azoles such as voriconazole are chosen for yeasts or resistant species. Drops are given frequently at the start and tapered slowly over weeks as the ulcer responds. Systemic antifungals are added in deep or severe cases. Topical steroids are usually avoided early because they can worsen fungal growth, and surgery is considered if there is impending perforation or uncontrolled disease.

FAQs About Fungal Keratitis

How is fungal keratitis different from bacterial keratitis?

Fungal keratitis often follows plant trauma, progresses more slowly, and can show feathery edged infiltrates or satellite lesions. It responds poorly to standard antibacterial drops and needs specific antifungals for control.

Can I use steroid drops if I have fungal keratitis?

Steroids are generally avoided in the early phase because they suppress local immunity and can speed fungal spread. They are used later only under close specialist supervision once antifungals have started to work.

How long does treatment for fungal keratitis take?

Therapy often lasts many weeks or longer, with frequent follow up visits. Stopping medicine too early can lead to relapse, so the schedule is guided by clinical response and culture results.

Can fungal keratitis be prevented after a plant injury?

Prompt evaluation after any significant eye injury with plant material is very helpful. Doctors may start prophylactic antimicrobials, give protective advice, and schedule close follow up to catch early fungal changes.