Affiliation:
1. Department of Ocular Microbiology, Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirapalli 620001, India
Abstract
SUMMARY
Fungi may infect the cornea, orbit and other ocular structures. Species
of
Fusarium
,
Aspergillus
,
Candida
,
dematiaceous fungi, and
Scedosporium
predominate. Diagnosis is
aided by recognition of typical clinical features and by direct
microscopic detection of fungi in scrapes, biopsy specimens, and other
samples. Culture confirms the diagnosis. Histopathological,
immunohistochemical, or DNA-based tests may also be needed.
Pathogenesis involves agent (invasiveness, toxigenicity) and host
factors. Specific antifungal therapy is instituted as soon as the
diagnosis is made. Amphotericin B by various routes is the mainstay of
treatment for life-threatening and severe ophthalmic mycoses. Topical
natamycin is usually the first choice for filamentous fungal keratitis,
and topical amphotericin B is the first choice for yeast keratitis.
Increasingly, the triazoles itraconazole and fluconazole are being
evaluated as therapeutic options in ophthalmic mycoses. Medical therapy
alone does not usually suffice for invasive fungal orbital infections,
scleritis, and keratitis due to
Fusarium
spp.,
Lasiodiplodia theobromae
, and
Pythium insidiosum
.
Surgical debridement is essential in orbital infections, while various
surgical procedures may be required for other infections not responding
to medical therapy. Corticosteroids are contraindicated in most
ophthalmic mycoses; therefore, other methods are being sought to
control inflammatory tissue damage. Fungal infections following
ophthalmic surgical procedures, in patients with AIDS, and due to use
of various ocular biomaterials are unique subsets of ophthalmic
mycoses. Future research needs to focus on the development of rapid,
species-specific diagnostic aids, broad-spectrum fungicidal compounds
that are active by various routes, and therapeutic modalities which
curtail the harmful effects of fungus- and host tissue-derived
factors.
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Microbiology (medical),Public Health, Environmental and Occupational Health,General Immunology and Microbiology,Epidemiology
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