Toxic non-inflammatory fungal keratitis

Purpose: To report a new entity called “toxic non?inflammatory fungal keratitis.” Methods: Eyes manifesting infective keratitis with a history of prior administration of topical steroids were included in the study. The details pertaining to the type of injury, duration of injury, and primary treatment for corneal trauma were meticulously documented. The corneal tissues were scraped from the patients and were analyzed for fungal filaments by using a 10% KOH mount under a compound microscope. Moreover, these scraped materials were plated on blood agar and Sabouraud dextrose agar plates. Results: The corneal ulcers displayed a disproportionately reduced intensity of pain and improved visual acuity. Further, 10% KOH revealed profuse fungal filaments with few inflammatory cells in all the patients. The anterior chamber cells and flare were either reduced or entirely absent. There was no evidence of lid edema and surrounding corneal edema in any of the patients. The mean healing period was 28.8 days (standard deviation (SD): 10.05). The KOH mount revealed the presence of confluent fungal hyphae with a few inflammatory cell infiltrates. The Aspergillus species and Fusarium species were found in 47% and 40% of the cases, respectively. Conclusion: Toxic non?inflammatory fungal keratitis following steroid therapy needs to be considered in fungal ulcers with disproportionately less pain and good visual acuity. The fungal ulcers with altered clinical signs of classical inflammation need to be assessed for topical steroid misuse.

Ocular sparganosis.

A 50-year-old male attended outpatients department with complaints of irritation, foreign body sensation and mild redness in his right eye. On examination a conjunctival nodule was found with localised inflammation. All investigations were normal. Surgical excision of the nodule was contemplated. During local dressing a live tapeworm about 20 cm in length and 3 mm in breadth emerged. Pathological examination confirmed it to be a tapeworm spirometra. The case was diagnosed to be ocular sparganosis.