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   Table of Contents      
ARTICLES
Year : 1979  |  Volume : 27  |  Issue : 3  |  Page : 55-56

Keratomycosis (A case report due to Mucormycosis)


Department of Ophthalmology, Medical College, Aurangabad, India

Correspondence Address:
D L Maria
Department of Ophthalmology, Medical College, Aurangabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 511293

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How to cite this article:
Maria D L, Deshpande S P, Kamble B S. Keratomycosis (A case report due to Mucormycosis). Indian J Ophthalmol 1979;27:55-6

How to cite this URL:
Maria D L, Deshpande S P, Kamble B S. Keratomycosis (A case report due to Mucormycosis). Indian J Ophthalmol [serial online] 1979 [cited 2020 Oct 29];27:55-6. Available from: https://www.ijo.in/text.asp?1979/27/3/55/31228

Corneal ulcers are of every day occurance and are the commonest cause of blindness in the poor class of people, because they are more prone to injury and infection and neglect treatment.

Fungus is known to cause disease in man since 1839, when Lagenback[8] first described the fungus causing thrush but ocular affection due to fungus was first described by Leber[9] in 1879, who demonstrated Aspergillus of cornea causing hypopyon. Subsequently, more than thirty species of saphrophytic fungi have been identi­fied as the causative agents of exogenous keratomycosis.

This case is being reported due to rarity of this type of fungus infection and difficulty in treatment.


  Case report Top


A thirty years old male patient from a local school attended the ophthalmic out patient department of Medical College Hospital, Aurangabad in the 3rd week of December 1977 with complaints of watering, photo­phobia and pain in the right eye following the entry of some dust particle two days prior to his visit to the hospital.

On examination his vision was 6/18. There was slight greyish infiltration in the central part of the cornea with circumcorneal congestion. He was put on atropine, sulphacetamide and soframycin eye drops and chloromy­cetin eye ointment with systemic orisul. He was admitted in the ward on 26th December 1977 because of no improvement. There was still no staining. Same treat­ment was continued in the ward with svstemic septran tablets and subconjunctival genticyn. Smear examina­tion did not reveal bacteria or fungus. Swab from the keratic area was sent for culture for fungus infection. He was discharged on 3-1-1978 as per his request. Patient was re-admitted on 11-1-1978 with a dense white infiltration and greyish striae going to the periphery with hypopyon. Now staining was positive, vision was reduced to finger counting one metre.

He was again put on the same treatment with chloromycetin capsule systemically and neosporine eye ointment replacing chloromycetin locally along with B complex, vitamin C and A. Investigations like V.D.R.L., blood sugar, urine, stool were normal. E.S.R. was 24mm. first hour, Hb.% was 11 gms., culture report was received on 18th January 1978 as mucor grown with description given in introduction. Now all antibiotics both locally, systemically were stopped except atropine eye drops.

Nystatin tablets one Q.I.D. with Vitamin C, B Complex and Vitamin A was started. Ulcer was cauter­ized with pure carbolic acid. Amphotericin B was procured from M/s Squibb company, Bombay and 0.5% eye drops prepared in distilled water were started at half hourly interval with Crooks collosal Iodine systemically. The picture was waxing and waning. Second carbolic acid cautery was done on 3-2-78. Patient developed severe headache on 5-2-78 with pain in the eye due to rise of intra ocular tension. Diamox one tablet twice a day with novalgin was started. Nystatin was stopped after 14 days therapy. On 7.2-78 subcon­junctival amphotericin B was given. On 8-2-78 Grisofulvin tablets two, three times a day were started systemically. Diamox was reduced to ˝ tablet twice a day.

Strength of Amphotericin B drops was increased to 0.8%, Crooks collosal Iodine was omitted. Scraping from the ulcer was again sent for culture. The report was sterile. Hypopyon disappeared on 10-2-78, eye became quiet by 14-2-78. Bandage was discarded and same treatment was continued and patient was discharged on 17-2-78. After 14 days of Grisofulvin therapy dose was reduced to one tablet three times a day, atropine drops three times a day and Amphotericin six times a day. This regime was continued for three months. Grisofulvin was stopped but Amphotericin with atropine was continued for further two months with reduced frequency. The eye was left with dense white opacity at the site of ulcer.


  Discussion Top


Chick and Conant reviewed the literature with 148 cases. He treated his cases with myco:,tatin drops, copper drops 0.125%, 10% sodium propionate ointment. Chin et al[5] used Amphotericin B in 0.5% aqueous form and pimarcin 5%. Agarwal and Khoslal reported 6 cases of keratomycosis. Sood et a1[13], reported 32 cases of fungi ulcers out of 159 consecutive cases of hypopyon ulcers (an incidence of 20.1%). Ahuja et a1[2], studied the effect of hamycin suspension in experimental keratomycosis. Siva Reddy et al[12], reported 36 cases of mycotic keratitis.

Maskati[10], reported two rare cases due to microsporium canis and trichoderma out of 6 cases of keratomycosis. Shukla et al 1977, reported 17 cases of keratomycosis treated with Crooks collosal Argentum drops with systemic collosal Iodine. Sree Nivas Rao and Rama Krishna[14] reported 13 cases of fungal infection. Majority of reported cases of keratomycosis are due to Aspergillus fumigatus and Candida albicans. Ferry[6] found in 34 cases of cereberal mucormycosis, proptosis and homolateral ophthalmoplegia, corneal oedema with anaes­thesia. Gass' isolated one case of mucor in keratomycosis infection.

Chin et al[5] used Amhotericin B in 0.5% aqueous form. Pimarcin, another antifungal agent is quite effective and non-irritating. The patients responding to Amphotericin B required many weeks or months of therapy as reported by Anderson et al. In the present case the therapy was continued almost for 4 to 5 months. Chaddah and Agarwal[4], used Amphotericin B ointment 10% twice daily for 2z to 5 weeks for complete cure.

The problem of treatment of mycotic ulcer is still today an open chapter. Various per­mutations and combinations of drops, oin­tments, cauterising agents have been tried by various authors.


  Summary Top


A case of keratomycosis due to extremely rare fungus infection by mucormycosis cured with Amphotericin B drops has been reported[15].

 
  References Top

1.
Agarwal L.P. and Khosla P.K., 1967, Arch. Ophthal., 1, 145.  Back to cited text no. 1
    
2.
Ahuja et al, 1967, Jour, of All India Ophth. Soc., 15, 19.  Back to cited text no. 2
    
3.
Chick, E. Wand Conant N.F., 1962, Invest.  Back to cited text no. 3
    
4.
Chaddah and Agarwal, 1978, Ind. Jour. Of Ophth., 26, 1,9.  Back to cited text no. 4
    
5.
Chin G N., Hyndink R.A., Kwasmy G.P. and Schultz R.O., 1975, Anzer.Jour. Ophth., 79, 121.   Back to cited text no. 5
    
6.
Ferry A.P., 1961, Survey Ophrhal., 6, 1.  Back to cited text no. 6
    
7.
Gass J.D.M., 1961, Arch. of'Ophth., 65, 226.  Back to cited text no. 7
    
8.
Lagenback C.J.M., 1839. Comptzy Weimer 12, 144 (Quoted from Modern Ophthalmology Vol. 2, By Arnold Sorsby 19; 3.   Back to cited text no. 8
    
9.
Leber T., 1879, Graefes Arch. Ophthal., 25, 285.  Back to cited text no. 9
    
10.
Maskati B.T., 1973, Proceeding of All India Ophth. Soc., Vol. XXIX and XXX.  Back to cited text no. 10
    
11.
Puttanna S.T., 1965, Jour. of All Ind. Ophth, Soc., 15, 11.  Back to cited text no. 11
    
12.
P. Siva Reddy, O.M. Satyendran, H. Satapathy, H. Vijay Kumar and P. Ranga Reddy, 1962, Ind. Jour. Ophthal., 20, 101.  Back to cited text no. 12
    
13.
Sood N.N., Ratnaraj A., Shenoy B.P., Madhavan H.N., 1968, Orient. Arch, of Ophth.. 6, 100.  Back to cited text no. 13
    
14.
Sree Nivasa Rao P.N. and Rama Krishan 1967, Indian Jour. of Path. and Bact.  Back to cited text no. 14
    
15.
Yahya O.A., Killiamson J., Gorder AN , Dyer, 1969, Brit. Jour, of Ophthal., 26,127.  Back to cited text no. 15
    




 

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