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Ophthalmology and Visual Sciences

Fungal keratitis

Fungal keratitis

Category(ies): Cornea
Contributor: Jesse Vislisel, MD, John Chen, MD, PhD
Photographer: Brice Critser, CRA; Carol Chan, CRA; Antoinette Venckus, CRA; Stefani Karakas, CRA

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

Figure 1
Contributor: Jesse Vislisel, MD
Photographer: Antoinette Venckus, CRA (1a, 1c); Stefani Karakas, CRA (1b); Brice 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.

Figure 2
Contributor: Jesse Vislisel, MD

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.

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