Year : 1981 | Volume
: 29 | Issue : 4 | Page : 489--493
Study of fungus infection of the eye in health, ocular diseases, and in general malnutrition
Department of Ophthalmology, S.P. Medical College, Bikaner (Rajasthan), India
S P Mathur
Department of Ophthalmology, S.P. Medical College, Bikaner (Rajasthan)
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Mathur S P. Study of fungus infection of the eye in health, ocular diseases, and in general malnutrition.Indian J Ophthalmol 1981;29:489-493
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Mathur S P. Study of fungus infection of the eye in health, ocular diseases, and in general malnutrition. Indian J Ophthalmol [serial online] 1981 [cited 2021 Jan 23 ];29:489-493
Available from: https://www.ijo.in/text.asp?1981/29/4/489/30962
The study has been divided in following parts
Study of fungal flora in clinically healthy conjunctiva, and also before and after topical use of antibiotics and cortisone.Study of fungal flora in Ocular inflammations.Study of fungal flora in the conjunctiva in cases of malnutrition.In-vitro and in-vivo study of the effect of silver nitrate, zinc sulphate, boric acid, copper sulphate, Tolnaftatc and Multifungin, on the conjunctival fungal flora.
METHOD AND MATERIAL
Smear was collected from the conjunctival sac and cultured on Sabouraud's agar for 30 days. Subcultures were made for identification and for in-vitro study.
Normal conjunctiva found to be free from fungus, were prescribed topical application of antibiotic-cortisone ointment once at bedtime for 15 days. Smears were collected once again and cultured to discover the fungal flora.
Smears and cultures were done from patients suffering from stye, chalazion, blepharitis, dacryo-cystitis, conjunctivitis, suppurative keratitis, and iridocylitis.
Similar studies were undertaken in cases of malnutrition without any clinical inflammation of the outer eye or adenexa.
In order to find out an effective antifungal drug which could be used topically, an in-vitro study was taken up with following drugs
Silver nitrate 1% solution.
Zine sulphate 0.5% solution.
Boric acid 5% solution.
Copper sulphate 0.25% solution.
Tolnaftate 2% market preparation Tinaderm.
Multifungin 2% market preparation solution.
The culture medium was suitably mixed with these drugs and equal quantity of fungus suspension of only those fungii isolated in the conjunctiva previously, was inoculated, along with controls. Observations were made every alternate day for 20 days.
For in-vivo study the drug solutions were given to the patients whose conjunctiva were positive for fungal flora, to be put topically twice a day, and after 6 days, smears were again cultured.
I.A. Control (Normal) cases studied= 100 Positive for fungus 20 (20%)
Type of fungii
Aspergillus - 5 Tricophyton -2
Alternaria - 5 Mucor -2
Penicillium - 4 Unidentified -2
1. B. Cases after topical use of antibiotics and cortisone:
Eye studied 20, Positive for fungus -10=50%
Aspergillus -- 3 Alternaria- -3
Candida .Albicans 2 penicillium -1
Unidentified - 2 Double flora-1
2. A. Fungal flora in ocular diseases:
Stye, chalazion, blepharitis -cases studied = 27
Positive for fungus - 5 cases=19% Type of fungus Aspergillus - 2 cases. Penicillium - I case. Alternaria - 2 cases.
2.B Dacryocytitis - case studied = 10 Positive for fungus -- 3 Cases= 30% Type of fungus - Aspergillus -2 Penicillium -1
2. C. Conjuntivitis - cases studied = 44 Positive for fungus - 14 = 32% Type - Aspergillus - 7 Candida Albicans -2 Unidentified -1
2. D. Suppurative keratitis-cases studied = 43 Positive for fungus- 18=42% Type - Aspergillus -5 Candida Albicans -2 Alternaria -3 Helminthosporium -2 Mucor -2 Curvularia -1 Penicillium -2 Unidentified -1
2. E. Iridocylitis - cases studied = 9 Positive for fungus - 2 = 22% Type- Penicillium Aspergillus -1
3A Fungal flora in cases of malnutrition with out ocular inflammation :
Cases studied = 50. Fungus positive -18 - 36%
Types - Candida Albicans -7 Mucor -1 Penicillium -6 Alternaria -1 Aspergillus -4
3.B. Type of malnutrition
Marasmus 9 cases - 5 fungus positive Marasmus + Maningitis -6 cases -2 fungus + ive Marasmus + Kwashiorkor -1 case -1 fungus + ive Marasmus Primary Complex -1 case -l fungus + ive Marasmus -1Dysentry -2 cases -1 fungus + ive Marasmus -i- Fevers -I1 cases -3 fungus 4- ive Protein calorie malnutrition 14 cases -4 fungus + ive Multiple vitamin deficiency 1 case -1 fungus + ive
3. C. Age incidence in fungus positive cases -
0 - 1 year -2 cases
13 months - 2 years -9 cases
25 months - 3 years -2 cases
37 months - 4 years -3 cases
Above 4 years -2 cases
3. D. Sex incidence in fungus positive cases -
Males 11 out of 35 = 31%
Females 7 out of 15 = 47%
3.E. Education of parents in fungus positive cases-
Uneducated 27, fungus positive 12 = 44% 1 st to 5th class 9, fungus positive 3 = 33% 6th to 10th class 8, fungus positive 3 - 37% 11th class and more 6, all fungus negative.
3.F. Economic status in fungus positive cases - Below R. 100 p.m. -5, fungus positive 4 = 80% Rs. 101 to Rs. 200 p.m. -12, fungus posivive 5 = 42% Rs. 201 to Rs. 300 p.m. - 6, fungus positive 3 = 19% Rs. 301 to Rs. 400 p.m. -3, fungus positive 1=33% Rs. 400 and above -14, fungus positive 5=36%
20% of normal conjunctiva, without any clinical evidence of local or systemic disease, were positive for fungus on culture.
50% of the conjunctiva, which were negative on fungus culture initially got positive after the use of antibiotics and cortisone topically.
Among the csses with local inflammation, fungus positive were 19% with inflammation of lid, 30% with dacryocystitis, 32% with conjunctivitis, 42% with suppurative keratitis, and 22% with iridocyclitis.
The incidence of conjunctival fungal flora in cases of Malnutrition was 36%. Majority of these cases were in second year of their life.
There were more female children in the proportion of 47 : 31.
Regarding the type of fungus infection, Aspergillus was most commonly found in the normal conjunctiva, after topical application of antibiotic and cortisone, and inflammatory conditions of the eye and adenexa. While Candida Albicans was most frequently found in cases of malnutrition, followed by Penicillium and then Aspergillus. This suggests that there is some metabolic change in Aspergillus in cases of malnutrition which effects its growth, without effecting the growth of Candida Albicans.
The effectivity of drugs tried against each fungus in-vitro show that there is no effect of Copper sulphate, Zinc sulphate, Silver nitrate, and Boric acid. Tolnaftate seems to be only partially effective against Penicillium, Alternaria, Helminthosporium, and Curvularia. Multifungin seems to be most effective in all except Helm inthosporium, where it is partially effective.
When these drugs were used in patients (invivo) it was noticed that Multifungin drops were most effective in all the patients against all the fungii found in the conjunctiva. Tolnaftate was partially effective, while Copper sulphate, Zinc sulphate and Silver nitrate, in that order, showed little effect.
Clinically in the patients with inflammation of eye and adenexa, a more rapid healing was evident after eradication of fungus from the conjunctiva. Both Tolnaftate, and Multifungin drops have been used prophylactically in patients for intra-ocular surgery with beneficial results. Except that these drugs cause slight smarting sensation in the eye for about a second, no other untoward effect was seen after their instillation.
Presence of fungus in conjunctival sac is quite common in normal, after tipical instillation of antibiotics and cortisone, inflammations of eye and adenexa, and iii cases of malnutrition.
Amongst various anti-fungal drugs readily available, eradication of the fungus infection can be done most effectively with multifungin, and to a lesser extent by tolnaftate.
It is suggested that these drugs could be used with benefit as prophylactic and curative measures in cases of malnutrition, for intraocular surgery.