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Exogenous mycotic infections of the eye and adnexia
Abstract:
Three cases of exogenous mycotic infections of the eye are presented. The first is a case of keratitis in a patient suffering from glaucoma simplex who removed a foreign body from the cornea, caused by Fusarium solani, generally known as a saprophytic soil and plant inhabitant. As factors predisposing the patient to infection, trauma to the cornea like injury by a foreign body, as well as the preexisting disease of the eye, are discussed. The other case illustrates the change in the pathogenicity of an otherwise innocent fungus like Penicillium, which penetrated the sclera after injury of the eye by a broken airpiece of a drill and caused a severe endophathalmitis. The infection responded well to treatment with 5-fluorocytosine. The last case represents a rather mild well-known mycotic infection by Streptomyces somaliensis causing canaliculitis in a patient admitted for cataract surgery. Curettage of the infected canaliculus followed by iodine washout proved to be effective. The importance of the early clinical and laboratory diagnosis in order to avoid mistreatment with antibiotics and steroids and to ensure the right antimycotic treatment is stressed.
Insights
This study presents three cases of exogenous fungal eye infections, including keratitis and endophthalmitis. Early diagnosis and appropriate antifungal treatment are crucial for managing these serious ocular mycoses.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Exogenous mycotic infections of the eye are uncommon but can lead to severe visual impairment.
- Risk factors include corneal trauma, foreign bodies, and pre-existing ocular conditions.
Observation:
- Case 1: Fusarium solani keratitis in a glaucoma patient after corneal foreign body removal.
- Case 2: Penicillium endophthalmitis following scleral penetration by a drill fragment, treated successfully with 5-fluorocytosine.
- Case 3: Streptomyces somaliensis canaliculitis in a patient undergoing cataract surgery, treated with curettage and iodine washout.
Findings:
- Ocular trauma and pre-existing glaucoma are significant predisposing factors for fungal keratitis.
- Fungi like Penicillium can exhibit increased pathogenicity after ocular injury.
- Prompt diagnosis and targeted antifungal therapy are essential for favorable outcomes in mycotic endophthalmitis and canaliculitis.
Implications:
- Highlights the importance of considering fungal etiology in unexplained ocular infections, especially post-trauma.
- Emphasizes the need for early clinical and laboratory diagnosis to guide appropriate antimycotic treatment.
- Warns against the misuse of antibiotics and steroids, which can exacerbate fungal infections.