|A Fungal Infection||Symptoms||Treatment of Mycotic Keratitis|
|Resources and Research|
A Fungal Invection
Fungal keratitis is an infection of the cornea (the clear outer layer of the eyeball). It typically occurs when fungus gets into the eye as a result of injury or contact lens use.
As the use of contact lenses increases, so does the prevalence of fungal keratitis eye disease in that population, particularly among contact wearers in developing countries.
Without proper treatment, or if the patient has a compromised immune system, the disease can lead to vision impairment or even blindness. With proper treatment, in most cases the eye can make a full recovery.
Fungal eye infections can be dangerous. That was made clear to the American public in the spring of 2006. In April of that year, Bausch and Lomb issued a recall of contact lens solution that had been contaminated by the fungus Fusarium. More than 100 customers, mostly in Asia, had contracted a fungal eye infection after using the Bausch and Lomb solution. In that same week Congress debated the use of Fusarium as a means of killing drug crops.
Fungal keratitis is also known as “keramycosis.” Keramycosis is a Latin term that is easy enough to translate if we know the two words that are combined to form the word. “Keratitis” refers to an inflammation of the cornea, and may be caused by bacteria, viruses, amoebae, orfungi. “Mycology” is the study of fungi. As the joined-together name suggests, keramycosis is an inflammation of the cornea that is caused by a fungus. Several species of fungus can contribute to this condition. They include aspergillus, fusarium, candida, and several other species of fungus. Aspergillus and Fusarium are the species of fungus that are most often involved in fungal keratitis.
Fungal keratitis is a dangerous and potentially blinding condition. This article includes information on how people can get the disease, how the disease affects the eye, how to treat the disease; and a brief description of those populations that are most vulnerable to the disease.
The eye suffering from mycotic keratitis will hurt, appear read and inflamed, and become either dry or creamy on the surface.
The first symptom of fungal keratitis the patient may notice is severe eye pain. The pain may lessen as the disease progresses. The disease will progress through the eye from front to back.
The cornea may change color and appear dull grey, and the surface of the eye may become dry and rough due to the spread of the fungus. Alternately, scratches on the eye caused by irritation from the fungus may produce a creamy fluid on the surface of the eye.
Next the disease will impact the middle layer of the eye, or the uvea. Swelling of the uvea is likely to occur.
As the disease progresses further the aqueous will also suffer. The aqueous is the rearmost layer of the eye. The eye will redden and pus will be present in the aqueous.
As the disease progresses the appearance of the eye may more closely resemble an eye suffering from bacterial keratitis, and physicians should take great care to determine which form of keratitis they are treating.
People who live in countries where the weather is warm are more likely to suffer from mycotic keratitis. This is particularly true of people who live in a tropical environment. This is particularly true of fungal keratitis that follows an eye injury. The reason for this is that the fungus survives better in warm weather than in cold. Mycotic keratitis suffered in colder regions is more often contracted through contact lenses or following the use of topical steroids.
Agricultural workers are more at risk than other populations, because they work with plants that may host the fungus. Contact lens wearers in developing countries are at greater risk than contact lens wearers in developed countries. Individuals with compromised immune systems may have difficulty recovering from the disease. This is because while the antifungal drugs are good at slowing the growth of the fungi, they may not be able to destroy the fungus completely. A strong immune system will in all likelihood be sufficient to finish off the fungus, whereas a compromised immune system may not.
Treatment of Mycotic Keratitis | Keramycosis Treatment
The medical professional must first confirm that the cause of the keratitis is fungal, rather than viral, bacterial, or otherwise. That identification is made by taking a tiny sample of tissue from the eye, and examining the sample carefully. Once confirmed, the doctor may begin treatment.
Treatment of fungal keratitis is time-consuming. The treatment for fungal keratitis often must take four weeks or more. The treatment often requires application of drugs but also surgical procedures to remove dead tissue, and the treatment can be complicated if the physician does not know the proper cause of the disease.
The cause of the disease is a fungus, and the disease is best treated with an anti-fungal medicine. Natamycin is commonly used to treat fungal keratitis. Natamycin is a naturally-occurring agent that is used as a food preservative due to its ability to prevent the growth of molds. Voriconazole is another drug that is gaining favor. Voriconazole slows the growth of fungi. Other anti-fungal drugs include amphotericin (a very strong anti-fungal agent, with strong warnings about side effects) and flucytosine.
Antibiotics are also used in the treatment of fungal keratitis in order to kill bacteria, if necessary. Steroids are strongly discouraged. They will assist the growth of the fungus and make the disease worse.
If the disease has progressed to the back of the eye (the aqueous), it may be difficult for the anti-fungal drugs to penetrate that deeply into the eye. The recommended method of making sure the drugs reach that part of the eye is to debride the cornea. Debridement is the removal of dead or damaged tissue, in this case the removal of fungal-contaminated tissue from the affected eye.If the cornea has been damaged, a physician may recommend corneal transplant. This is a procedure that replaces damaged corneal tissue with healthy corneal tissue from an organ bank.
References and Resources
Sonal S. Tuli, “Fungal Keratitis”, Clin Opthalmol 5 (2011): 275-279, doi: 10.2147/OPTH.S10819
“Fusarium Keratitis”, Centers for Disease Control and Prevention, last updated June 7, 2010, http://www.cdc.gov/nczved/divisions/dfbmd/diseases/fusarium_keratitis/
“Fungal Keratitis”, Handbook of Ocular Disease Management, accessed on August 17, 2011, http://cms.revoptom.com/handbook/oct02_sec3_3.htm
Yashika Inderjeet, “Review of Fungal Keratitis”, International Center for Eyecare Education, posted June 25, 2010, http://www.icee.org/publications/research/pdfs/epidemiology/080430/Epidemiology_Review_of_Fungal_Keratitis.pdf
M. Srinivasan, “Fungal keratitis”, Current Opinion in Ophthalmology 15 (2004): 321–327 http://www.aspergillus.org.uk/secure/articles/pdfs/srinivasan04.pdf
“Eye Infections”, Doctor Fungus, accessed on August 17, 2011, http://www.doctorfungus.org/mycoses/human/other/eyeinfections.php
“Uveitis”, PubMed Health by the National Center for Biotechnology Information, last updated July 28, 2010, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002000/
“Fact Sheet Natamycin”, Royal DSM N.V., accessed on August 16, 2011. http://www.dsm.com/en_US/downloads/dfsd/fact_sheet_natamycin.pdf
“Voriconazole”, PubMed Health by the National Center for Biotechnology Information, last updated January 1, 2010, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000305/
“Amphotericin B injection”, Medline Plus, the National Institute of Health, accessed on August 16, 2011, http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682643.html
Jeremy Bigwood, “Drug Warriors Push Eye-eating Fungus”, In These Times 30:6 (June 2006), 11.
“Background Paper…”, Fifth Review Conference of the States, The United Nations, Geneva, November 19 to December 7 2001, http://www.un.org/disarmament/WMD/Bio/pdf/bwccnfv4.pdf
John Otis, “A Controversial Weapon in the War on Drugs”, Houston Chronicle, January 18, 2007, http://www.november.org/stayinfo/breaking07/Fungus.html
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