Concluded Case

Atypical appeance of corneal ulcer

patient present with pain redness fb sensation ... history of tongue and quack manipulation anterior chamber normal in slit oblique illumination.... Iris completely round and dilated due to mydriatic.. kindly suggest diagnosis and management.

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Concluded answer

Pigmented keratomycosis debride gently sloughed area prepare slide mount with KOH examine under microscope in the lab Apply Hydrogen peroxide to the debrided corneal surface with sterlized swab stick Natamycin e/d hourlly basis for 48 hours followed by tapering after confirmed microbiologically by smear , an additional antifungal itraconaze is added in case of inadequare response. Oral fluconazole 150 mg od Homide 2% eye drops twice Closely follow the patient for one week Superficial keratectomy for superficial plaque and infiltrates Closely monitor the prgress if at any time large perforaration occur be prepared for therapeutic keratoplasty , most of the times it is not reqired and patient recovers completely

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Dematiaceous fungal keratitis.  Fungal culture and sensitivity 10%KOH mount Natamycin can be started ,if response not seen 7days voriconazole prepared eye drops can be added. Gatiflox eye drops 8times/day Possible do AS-OCT for level of involvement then u may plan for THERAPEUTIC PENETRATING KERATOPLASTY in future if not responding.

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Pigmented keratomycosis debride gently sloughed area prepare slide mount with KOH examine under microscope in the lab Apply Hydrogen peroxide to the debrided corneal surface with sterlized swab stick Natamycin e/d hourlly basis for 48 hours followed by tapering after confirmed microbiologically by smear , an additional antifungal itraconaze is added in case of inadequare response. Oral fluconazole 150 mg od Homide 2% eye drops twice Closely follow the patient for one week Superficial keratectomy for superficial plaque and infiltrates Closely monitor the prgress if at any time large perforaration occur be prepared for therapeutic keratoplasty , most of the times it is not reqired and patient recovers completely

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Mycotic keratitis Treat with antifungal agents

Fungal corneal ulcer :

Mycotic keratitis

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