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What Is Keratomycosis (Fungal Keratitis)?

Keratomycosis, or fungal keratitis, is a corneal infection caused by fungi such as Fusarium, Aspergillus, or yeast like Candida. The organism invades the corneal tissue, leading to inflammation, ulceration, and often slow, stubborn disease. It is more common in warm, humid climates and after plant related eye injuries. Contact lens wear, chronic surface disease, and prior steroid use also raise risk. Without timely treatment, fungal keratitis can cause severe scarring or perforation.

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What Is Keratomycosis (Fungal Keratitis)?

Keratomycosis, or fungal keratitis, is a corneal infection caused by fungi such as Fusarium, Aspergillus, or yeast like Candida. The organism invades the corneal tissue, leading to inflammation, ulceration, and often slow, stubborn disease. It is more common in warm, humid climates and after plant related eye injuries. Contact lens wear, chronic surface disease, and prior steroid use also raise risk. Without timely treatment, fungal keratitis can cause severe scarring or perforation.

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Causes and Risk Factors for Keratomycosis

Fungal keratitis often follows corneal trauma with organic matter, such as tree branches or crop debris, which inoculates fungi into the cornea. Long term contact lens wear, especially with poor hygiene or contaminated solutions, is another major risk. Chronic ocular surface disease, previous ocular surgery, or use of topical corticosteroids makes infection more likely to take hold. Systemic immunosuppression or uncontrolled diabetes can worsen the course. Identifying the likely source helps target prevention and early suspicion.

Symptoms and Clinical Features

Patients usually present with eye pain, redness, tearing, and blurred vision. Photophobia is common, and symptoms can progress over days to weeks. On slit lamp exam, fungal ulcers often show feathery or fuzzy edges, raised slough, or satellite lesions. There may be a dry looking surface and stromal infiltrates that extend deep. Hypopyon and endothelial plaques can be present in severe cases. The appearance can overlap with bacterial keratitis, so microbiologic testing is important.

How Is Keratomycosis Diagnosed?

Diagnosis relies on corneal scrapings for microscopy and culture. KOH or calcofluor white preparations can show fungal filaments quickly under the microscope. Cultures on appropriate media identify the organism and inform drug choice. In vivo confocal microscopy can sometimes visualize hyphae within the cornea. The clinician also reviews history for trauma, contact lens use, and prior steroid treatment. Distinguishing fungal from bacterial or acanthamoeba infection is critical because treatments differ.

How Is Keratomycosis Treated?

Treatment centers on intensive topical antifungal therapy, often with agents such as natamycin, amphotericin B, or voriconazole, depending on the organism. Drops are given frequently at first, sometimes hourly, and tapered slowly as the infection responds. Systemic antifungals are added for deep or severe disease. Topical steroids are generally avoided in the early phase because they can worsen fungal growth. Surgical options, including therapeutic penetrating keratoplasty, are considered if there is impending perforation or uncontrolled infection.

FAQs About Keratomycosis (Fungal Keratitis)

Is fungal keratitis more serious than bacterial keratitis?

Fungal keratitis often progresses more slowly but can be harder to treat and more likely to leave dense scars or require surgery. Early recognition and appropriate antifungal therapy are crucial. Delays in diagnosis worsen outcomes.

Can I use steroid eye drops if I have keratomycosis?

Steroid drops are usually avoided at the start because they suppress local immunity and can let fungi spread. In selected cases, small doses are introduced later under close supervision once antifungals have controlled the infection. Never start steroids for a painful red eye without medical advice.

How long does treatment for fungal keratitis last?

Therapy often continues for many weeks, with frequent visits to monitor healing. Stopping medicine too soon risks relapse. Your doctor will adjust the schedule based on clinical response and culture results.

Can fungal keratitis be prevented after a plant injury to the eye?

Prompt evaluation after any significant corneal injury, especially with soil or plant matter, helps. Doctors may start prophylactic antimicrobial drops and give clear instructions for follow up. Protective eyewear during outdoor work lowers the risk of such injuries.