[Keratomycosis: diagnosis and therapy]

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Context:

• Fungal keratitis diagnosis is often difficult, particularly in contact lens wearers presenting with atypical early infection signs.
• Typical clinical signs include pyramidal hypopyon, geographical corneal infiltration, and satellite lesions, which may be absent in early-stage infections.

Purpose:

• To highlight the diagnostic challenges of fungal keratitis.
• To emphasize the necessity of corneal debridement for enhanced antimycotic penetration.
• To discuss current and alternative therapeutic strategies for fungal keratitis.

Summary:

• Corneal debridement is essential for effective treatment, facilitating antimycotic drug penetration into the corneal stroma.
• Voriconazole is the current first-line treatment, but alternatives like posaconazole or caspofungin may be used based on microbiological diagnosis.
• Intracameral or intravitreal amphotericin B injections and concurrent steroid use are also discussed as treatment options.

Impact:

• Improved diagnostic and treatment strategies for fungal keratitis, especially in contact lens wearers.
• Potential for reduced visual impairment and vision loss associated with fungal keratitis.
• Guidance for clinicians on selecting appropriate antifungal agents and adjunctive therapies.