Learning Objectives:
- To learn the distinguishing features of keratitis of fungal origin
- To understand the diagnostic process for fungal keratitis
- To review the treatment of fungal keratitis.
Time Credit:
2 Hours
Case:
A 22 year old male presents for follow up of a corneal ulcer on the left eye. The patient originally came to your office 5 days ago after a fall in the woods while hiking. He says he tripped over a rock and fell face-first on the ground, scratching his left eye. He immediately had pain and photophobia in the eye, and presented to you hours later. His visual acuity was 20/30 in the left eye, and a small corneal ulcer was discovered. A corneal scraping was taken at the time and sent for culture and sensitivity, and the patient was sent home with antibiotics for the eye.
Over the past 5 days, you have been following the patient each day and have noted that the ulcer is slowly growing in size and depth of penetration. Today, the eye is still erythematous with a persistent anterior chamber reaction. A slight hypopyon not documented at previous visits is also noted. The results of the culture and sensitivity came back today and were negative for bacterial growth. The picture below was taken on day 3 of treatment.
What is the most likely diagnosis?
• Bacterial ulcer with non-compliance
INCORRECT Medication non-adherence is unlikely to be the cause of treatment failure in this patient, especially considering negative cultures.
• Herpes Simplex Keratitis
INCORRECT A dendritic ulcer is the classic feature of this disease, which is not seen in our patient.
• Peripheral Ulcerative Keratitis
INCORRECT This keratitis is characterized by a progressive ulceration and may be associated with systemic collagen vascular disease. Due to the history of eye trauma, and hypopyon formation, it is less likely that this is an inflammatory process, and more likely that it is an infectious process.
• Fungal Keratitis
CORRECT