Fungal Keratitis Follow-up
- Author: Daljit Singh, MBBS, MS, DSc; Chief Editor: Hampton Roy, Sr, MD more...
Further Outpatient Care
Most patients with fungal keratitis are treated on an outpatient basis.
Antifungal therapy generally should be maintained for 12 weeks with routine follow-up examinations.
Further Inpatient Care
Indications for inpatient care include clinical evidence of an impending corneal perforation or if the patient is unable to administer frequent eye drops. In such cases, inpatient care includes topical fortified antifungal therapy administered every hour around the clock with frequent monitoring for any signs of corneal perforation.
Inpatient & Outpatient Medications
The medications prescribed depend on the specific etiologic agent identified in cultures.
In general, amphotericin B should be prescribed to a patient presenting with a fungal ulcer suggestive of yeast infection (Candida species), and natamycin should be prescribed when a high suspicion exists for a filamentous fungus (eg, Fusarium species). Candida species are frequently more common in sick corneas, while Fusarium species are often more common after trauma.
Fluconazole or ketoconazole should be used in patients with deep stromal infection.
Fungal keratitis can lead to severe ocular infections involving any intraocular structure and can result in severe visual loss or even loss of the eye.
Corneal perforation is not unusual, and secondary endophthalmitis has been reported.
Prognosis depends on several factors, including the extent of corneal involvement upon presentation, the patient's health status (eg, immunocompromised), and the timing of establishing a clinical diagnosis confirmed by culture in the laboratory.
Patients with mild infections and an early microbiologic diagnosis have a good prognosis; however, controlling or eradicating an infection that spreads into the sclera or the intraocular structures is very difficult.
Approximately one third of fungal infections result in either medical treatment failure or corneal perforation.
Patients who wear contact lenses should consult their eye care professional concerning use of an appropriate cleaning/disinfecting product. (Patients should discontinue use of Bausch & Lomb ReNu with Moisture Lock contact lens solution.)
Patients should consider performing a “rub and rinse” lens cleaning method, rather than a no rub method, regardless of which cleaning/disinfecting solution used, in order to minimize the number of germs and to reduce the chances of infection.
Patients should continue to follow proper lens care practices. Wash their hands with soap and water and dry (lint-free method) them before handling lenses. Wear and replace lenses according to the schedule prescribed by their eye care professional. Follow the specific lens cleaning and storage guidelines from their eye care professional and the solution manufacturer. Keep the contact lens case clean and replace every 3-6 months.
Patients should remove the lenses and consult their eye care professional immediately if they experience symptoms, such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge, or swelling.
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