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Ophthalmology and Visual Sciences

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Fungal keratitis

Contributor: Jesse Vislisel, MD

Common feature of fungal keratitis classically include dry-appearing, elevated infiltrates with feathered margins and satellite lesions.

Figure 1.

Contributor: Jesse Vislisel, MD (Figures 1-3)

Photographers: Antoinette Venckus, CRA (1a, 1c); Stefani Karakas, CRA (1b); Crice Critser, CRA (1d)

Rapid progression of culture-positive, fulminant Fusarium keratitis over the course of one week.  Note the feathered edges, satellite lesions, and large hypopyon.  This case required urgent, therapeutic penetrating keratoplasty with anterior chamber washout using amphotericin B and voriconazole to clear the infection.

1st image. feathered edges, satellite lesions, and large hypopyon later in week. feathered edges, satellite lesions, and large hypopyon
after 7 days. feathered edges, satellite lesions, and large hypopyon Postoperative

Figure 2.

Confocal microscopy showing branching Fusarium filaments in vivo, obtained from the patient in Figure 1 upon her initial presentation.

Confocal microscopy showing branching Fusarium filaments in vivo, obtained from the patient in Figure 1 upon her initial presentation.

Figure 3.

Photographer: Carol Chan, CRA

Another patient with severe Fusarium keratitis, showing a late suppurative appearance mimicking bacterial keratitis.  This patient eventually developed intraocular extension and endophthalmitis.

suppurative appearance

slit lamp exam shows severe keratitis

Figure 4.

Contributor: John Chen, MD, PhD

Photographer:  Brice Critser, CRA

43-year-old male with fungal keratitis from Aspergillus. Note the feathery edges of the infiltrate and the elevated appearance of the lesion, which are commonly seen in fungal keratitis. There is also a 1 mm layered hypopyon

Fungal keratitis


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last updated: 02/11/2016

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