Fungal keratitis Treatment in UAE

Overview Of Fungal keratitis

Fungal keratitis is an infection of the cornea caused by fungal organisms, which can result in severe eye damage and potentially permanent vision loss if left untreated. It is less common than bacterial keratitis but more likely to occur in individuals with predisposing risk factors such as trauma, contact lens wear, and immunosuppression. Fungal species that typically cause keratitis include *Fusarium*, *Aspergillus*, *Candida*, and *Curvularia*. The infection usually arises after the cornea is injured, especially by plant material, and the fungi invade the corneal tissue. Fungal keratitis presents with symptoms such as eye pain, redness, photophobia (light sensitivity), blurred vision, and excessive tearing. Diagnosis is confirmed through microscopic examination, corneal scraping, and fungal cultures. Treatment requires antifungal medications, with more severe cases possibly requiring surgical intervention. If untreated, fungal keratitis can lead to serious complications such as corneal scarring, perforation, and loss of vision.

Symptoms of Fungal keratitis

The symptoms of fungal keratitis often resemble those of other forms of corneal infections, but they are typically more persistent and severe. Common symptoms include:
Eye Pain: A hallmark of fungal keratitis is significant eye pain, often described as deep or throbbing, which worsens with light exposure or blinking.
Redness: The affected eye becomes red due to inflammation of the conjunctiva and the blood vessels in the sclera.
Photophobia (Light Sensitivity): People with fungal keratitis experience increased sensitivity to light, which exacerbates discomfort.
Blurred Vision: Vision may become blurred or impaired as the infection progresses, especially if the corneal ulcer affects the central visual axis.
Excessive Tearing: There may be increased tear production in response to irritation from the infection.
Corneal Ulcer: On eye examination, a white or grayish ulcer with surrounding inflammation is typically seen, which may have a raised, irregular border indicative of fungal involvement.
Discharge: Some cases may produce a thick, purulent discharge, although this is more characteristic of bacterial infections.

Causes of Fungal keratitis

Fungal keratitis is primarily caused by fungal organisms that invade the cornea following trauma or in the presence of certain predisposing conditions. Common causes include:
Trauma: Injury to the eye, particularly from plant material like tree branches, soil, or agricultural dust, is one of the most significant risk factors for fungal keratitis. These injuries introduce fungal spores into the corneal tissue.
Contact Lens Use: Individuals who wear contact lenses, especially those who engage in poor hygiene practices, have an increased risk of developing fungal keratitis. Contact lenses can create an environment conducive to fungal growth and also act as a reservoir for fungi.
Immunocompromised States: People with weakened immune systems, such as those with HIV/AIDS, diabetes, or who are on immunosuppressive medications, are more susceptible to fungal infections, including keratitis.
Chronic Steroid Use: Long-term use of corticosteroids, particularly for treating ocular conditions, can suppress the immune system in the eye, making it easier for fungi to invade and cause infection.
Environmental Exposure: Living or working in environments where fungal spores are abundant, such as farming or construction, can increase the risk of fungal keratitis.
Ocular Surface Diseases: Conditions like dry eye, corneal dystrophies, or blepharitis can compromise the corneal surface, increasing the likelihood of fungal invasion.

Risk Factors of Fungal keratitis

Several factors can increase the likelihood of developing fungal keratitis, including:
Eye Trauma: Particularly trauma from organic materials such as soil, plant matter, or wood, which introduces fungal spores into the corneal tissue.
Contact Lens Use: Wearing contact lenses increases the risk of fungal infections due to potential contamination of the lenses and the compromised immune response when lenses are worn improperly.
Immunocompromised Conditions: Individuals with conditions that weaken the immune system, such as diabetes, HIV, or those undergoing chemotherapy, are more vulnerable to fungal infections.
Topical Steroid Use: Prolonged use of corticosteroids can suppress local immunity in the eye, making it easier for fungi to cause infection.
Environmental Exposure: Occupational or recreational exposure to environments rich in fungal spores, such as farming, construction work, or activities in damp or humid areas, can increase the risk of fungal keratitis.
Pre-existing Ocular Conditions: Dry eye disease, corneal surface disorders, or blepharitis increase susceptibility to infections by disrupting the normal protective mechanisms of the eye.

Prevention of Fungal keratitis

Preventing fungal keratitis primarily involves reducing risk factors and taking steps to protect the eyes from potential infections. Key preventive measures include:
Contact Lens Hygiene: Proper cleaning and disinfecting of contact lenses, as well as avoiding sleeping in lenses, can help reduce the risk of fungal infections.
Protection from Eye Injury: Wearing protective eyewear, especially when working with plant materials or in environments prone to fungal contamination, can prevent eye trauma that might introduce fungal spores into the cornea.
Prompt Treatment of Eye Injuries: Seeking medical attention for eye injuries, particularly those involving organic material, can help prevent infection and reduce the risk of fungal keratitis.
Managing Pre-existing Eye Conditions: Proper management of conditions like dry eye or blepharitis can help maintain the integrity of the ocular surface and reduce the risk of fungal invasion.
Judicious Use of Steroids: Steroids should be used cautiously and under the supervision of an ophthalmologist, especially in individuals at higher risk for infections.

Prognosis of Fungal keratitis

The prognosis for fungal keratitis depends on the severity of the infection, the timeliness of treatment, and the overall health of the patient. With early detection and appropriate antifungal treatment, the prognosis is generally favorable, with many patients experiencing full recovery. However, fungal keratitis can lead to permanent vision loss, particularly if it is not treated promptly or if complications such as corneal scarring or perforation occur. In cases where the infection is severe, the need for corneal transplant surgery may arise. Immunocompromised individuals or those with delayed treatment may have a poorer prognosis.

Complications of Fungal keratitis

Fungal keratitis can lead to several complications, particularly if the infection is severe or left untreated:
Corneal Scarring: A common complication, corneal scarring can occur as a result of the infection, potentially causing permanent vision loss, especially if the central cornea is affected.
Corneal Perforation: If the infection progresses and weakens the corneal tissue, it can lead to corneal perforation, which may result in loss of the eye and require emergency surgical intervention.
Endophthalmitis: In rare cases, fungal keratitis can lead to endophthalmitis, a serious infection within the eye that can result in systemic infection and vision loss.
Chronic Infection: Some fungal keratitis cases may become chronic, leading to recurrent infections, persistent pain, and long-term visual impairment.
Vision Loss: Severe infections that affect the central cornea or lead to significant scarring can result in permanent loss of vision, which may require a corneal transplant to restore sight.

Related Diseases of Fungal keratitis

Fungal keratitis is related to other types of ocular infections and conditions, including:
Bacterial Keratitis: Like fungal keratitis, bacterial keratitis involves an infection of the cornea, but it is caused by bacteria rather than fungi and is typically treated with antibiotics.
Herpetic Keratitis: A viral infection of the cornea caused by the herpes simplex virus, which can present with symptoms similar to those of fungal keratitis.
Acanthamoeba Keratitis: A rare but severe infection caused by the protozoan *Acanthamoeba*, often seen in contact lens wearers and characterized by intense pain and difficulty treating the infection.
Corneal Ulcers: Any infection or open sore of the cornea, whether caused by bacteria, fungi, or other pathogens, can lead to similar symptoms such as pain, redness, and blurred vision.

Treatment of Fungal keratitis

Treatment for fungal keratitis typically involves antifungal medications and, in severe cases, surgical intervention. Treatment options include: 1. **Topical Antifungal Medications**: The cornerstone of treatment is the use of antifungal eye drops. Common medications include natamycin, amphotericin B, and voriconazole. These drugs target the fungal organisms and prevent the infection from worsening. 2. **Systemic Antifungal Therapy**: In cases where the infection is severe or has spread, oral or intravenous antifungal drugs like fluconazole or itraconazole may be required to treat the infection more effectively. 3. **Steroid Use**: Steroids are typically avoided in the treatment of fungal keratitis, as they can suppress the local immune response and allow the infection to worsen. However, in some cases, corticosteroids may be used cautiously to manage inflammation once the infection is under control. 4. **Surgical Intervention**: In severe cases, surgical intervention may be necessary. This could include corneal debridement to remove infected tissue or a corneal transplant if the infection causes significant scarring or damage to the cornea. 5. **Pain Management**: Topical anesthetics and systemic pain relievers may be prescribed to help manage the discomfort associated with fungal keratitis, especially in the acute stages of the infection.

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