FUNGUS EYE DISEASE Blepharitis Keratitis POHS Endophthalmitis Orbital disease

Fungal Blepharitis Rare 1.Dermatophytes 2.Candida Poorly controlled DM

Fungal Keratitis 1.Fusarium (65%- tropics) 2.Candida (12.5%) 3.Curvularia (9%) 4.Aspergillus (4%- temperate) A) Filamentous Keratitis (Asp., Fusarium) TRAUMA by organic matter (wood)/ Rural No preexisting eye disease or immunosupression Grayish-white ulcer (indistinct, elevated margins) Feathery stromal infiltrates/ ring infiltrate Satellite lesions/ hypopyon

B) Candida Keratitis Chronic eye disease Immunocompromised Yellow-white ulcer Dense suppuration Management: Reculture/ deep scrapings/ corneal biopsy Exclude fungal dacryocystitis Debridement (daily for 1/52) Topical LONG 6/52 min (Natamycin- imidazole) Systemic (sleral involvement)/ itrakonazole PRK (25%)

POHS Histoplasma capsulatum/ Airborne Missisipi- Misouri river valleys (5-10%) Majority : asymptomatic fungaemia (URTI) Small minority: severe, disseminated (endophthalmitis)/ immunocompromised POHS Investigations: Skin test: 90% ve + XR: calcification (lung, liver, spleen) HLA -B7 (maculopathy)

Symptoms/ Signs: Asymptomatic unless maculopathy (metamorphopsia) 1.Atrophic histo-spots (immunologic reaction) 2.PPA 3.Peripheral linear streaks (chorioretinal atrophy) 4.CNV (20-45y)/ 5-10% 5.NO Vit. involvement Daily Amsler chart fellow eye if unilat. maculopathy with asymptomatic histospot in fellow eye Rx: Argon laser after FFA

Endophthalmitis A) Fusarium/ Asp.: rapid visual loss Exogenous: surgery, trauma, keratitis B) C. albicans/ opportunistic: Slow progression/ well tolerated Endogenous: 1.Drug addicts (SKIN) 2.Catheters (iv hyperalimentation) 3.Immunocompromised

Choroidal focus  retinal invasion (Roth spots)  vitreous (cotton ball)  string of pearls  endophthalmitis (retinal necrosis)  vit. organisation (traction RD) Rx: 5 FC+ Ketokonazole (3/52) iv amphotericin TPPV + intravit amphot 30% candidemia: candidiasis 80% candidiasis: chorioretinitis 85% endogenous endophth.: disseminated candidiasis

Fungal endophthalmitis following cataract surgery Rare (Western World- late presentation) Cluster infections (within 4/52) Developing countries (20%-India, isolated, early diffuse presentation) Aspergilus flavus Rx: TPPV+ antifungal agents Visual outcome: corneal involvement NO STEROIDS

Orbital Disease Aspergillus species Immunocompetent host (usually) Immunosupressed (sinoorbital aspergillosis) 1.Allergic fungal sinusitis (non-invasive/ children) 2.Invasive fungal sinusitis (tropics, Sudan) Slow, painless extension from sinuses to orbit and brain (months) High mortality: 80% Rx: surgery+ antifungal agents

MUCORMYCOSIS Opportunistic phycomycetes (Mucorales) 1.DK 2.MA/ uremia 3.Severe immunosuppression 4.Desferrioxamine Vascular occlusion- infarction- necrosis Sinusitis, pharyngitis, nasal discharge Multiple cranial nerve palsies CRAO Eschar (periorbital,nose, hard palate) LATE

Rx: PROMPT and AGGRESSIVE Metabolic deficit Surgical Amphotericin B (iv, locally) Hyperbaric oxygen