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Pharmacotherapy of fungal eye infections
B Manzouri1, G C Vafidis, R K Wyse
1Moorfields Eye Hospital NHS Trust, London, UK.
Abstract:
Fungal eye infections are rare. Trauma associated with contamination by vegetative material, contact lens wear and long term corticosteroid use are common risk factors. The aims of treatment are to preserve visual function, which depends on the rapid diagnosis and efficient administration of appropriate antifungal therapy. This necessitates a clinical suspicion of fungal aetiology and the taking of appropriate smears and cultures as early as possible to identify the fungal organism. Currently there are three main classes of drugs available for use in fungal eye infections: polyenes, azoles as derivatives of imidazoles, and 5-fluorocytosine. Of the polyenes, amphotericin B, natamycin and nystatin are of clinical ophthalmic use. Based on better pharmacokinetic profiles and spectra of antifungal activity, the triazoles are the agents of choice. Successful treatment of fungal keratitis depends on early initiation of specific therapy consisting of topically-applied antifungal agents since topical administration is most likely to provide the best opportunity for achieving therapeutic corneal levels. Hence, the molecular weight of the various antifungal agents is of importance since it influences their ability to penetrate the corneal epithelium. Systemic administration may be necessary for resistant fungal ulcers. For fungal endophthalmitis, to preserve visual function and eliminate the fungal pathogen, topical, systemic and possibly intraocular antifungal therapy is used, although some do not recommend use of systemic agents for exogenous endophthalmitis.
Insights
Fungal eye infections require prompt diagnosis and treatment with antifungal medications to preserve vision. Early, targeted therapy, often topical, is crucial for effective management of these rare but serious conditions.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal eye infections are uncommon but can lead to significant vision loss.
- Risk factors include trauma, contact lens wear, and corticosteroid use.
Purpose of the Study:
- To outline the diagnostic and therapeutic strategies for fungal eye infections.
- To emphasize the importance of early and specific antifungal treatment.
Main Methods:
- Review of current antifungal drug classes and their ophthalmic applications.
- Discussion of treatment approaches for fungal keratitis and endophthalmitis.
Main Results:
- Polyenes (amphotericin B, natamycin, nystatin) and azoles are key drug classes.
- Triazoles offer improved pharmacokinetic profiles and spectra of activity.
- Topical administration is preferred for corneal penetration, while systemic or intraocular routes may be needed for severe cases.
Conclusions:
- Early suspicion, diagnosis via smears and cultures, and prompt administration of appropriate antifungal therapy are vital.
- Treatment choice depends on the specific fungal pathogen and infection site, with topical agents often being the first line.