A 48 year old diabetic with orbital cellulitis presented with a corneal ulcer. An aqueous tap showed branched hyphae. Diagnosis is -

Ans. is 'b' i.e., Mycotic Ulcer Mycotic (fungal) corneal ulcero The incidence of corneal ulceration due to fungi has increased significantly due to long-term unwarranted use of antibiotic and steroid. The most common mode of infection is injury by vegetative material such as crop leaf, horn, wooden stick. The causative fungus are Aspergillus fumigatus (most common), Candida albicans and fusarium.Clinical featureso Symptoms are similar to bacterial comeal ulcers but in general they are less marked than the equal size bacterialulcer.On the other hand signs are very prominent, i.e. signs are more prominent than symptoms, o Following signs can be seen: -i) Greyish-white dry looking ulcer with the elevated rolled out feathery & hyphate margins.ii) Feathery finger like extension into surrounding stroma under intact epithelium.iii) A sterile immune ring (yellow line) of Wesseley.iv) Multiple small satellite lesions.v) Non-sterile (infected) hypopyon (Pseudohypopyon-Hence penetrated the endothelium)vi) Perforation is rare and comeal vascularization is conspicuously absent.Diagnosiso Examination of wet KOH will show:-i) Flamentous fungi (branched septate hyphae ):- Aspergillus fumigatus, Fusarium.ii) Non-filamentous (yeast like fungi): - Candida.Treatment of fungal corneal ulcero Treatment of comeal fungal ulcer involves:- 1) Specific (definitive) treatment, and 2) Adjunctive (concurrent) treatment.1) Definitive treatment: - It includes antifungal drugs: -A) Topical antifungals -i) For filamentous fungi (Aspergillus,fusarium):- Natamycin (5%) eye drops (drug of choice), Miconazole ointment, Amphotericin B drops.ii) For yeast (Candida): - Amphotericin B (Drug of choice), nystatin, flucytocine.B) Systemic antifungals: - May be required in severe cases. Fluconazole or ketoconazole may be used.2) Adjunctive/Concurrent therapy: - This follows the same principles as in any other infectious comeal diseases.# Cycloplegic (1% atropine ointment or drop is the DOC) should be used to: - i) Reduce pain from ciliary spasm; ii) Prevent posterior synaechiae; iii) Reduce uveal inflammation.# Topical steroids enhance fungal replication and comeal invasion and are contraindicated during early therapy of a fungal comeal ulcer.