Fungal eye infections are rare.
Trauma associated with contamination by vegetative material,
contact lens wear and long term
corticosteroid use are common risk factors. The aims of treatment are to preserve visual function, which depends on the rapid diagnosis and efficient administration of appropriate antifungal
therapy. This necessitates a clinical suspicion of fungal aetiology and the taking of appropriate smears and cultures as early as possible to identify the fungal organism. Currently there are three main classes of drugs available for use in
fungal eye infections:
polyenes,
azoles as derivatives of
imidazoles, and
5-fluorocytosine. Of the
polyenes,
amphotericin B,
natamycin and
nystatin are of clinical ophthalmic use. Based on better pharmacokinetic profiles and spectra of antifungal activity, the
triazoles are the agents of choice. Successful treatment of fungal
keratitis depends on early initiation of specific
therapy consisting of topically-applied
antifungal agents since
topical administration is most likely to provide the best opportunity for achieving therapeutic corneal levels. Hence, the molecular weight of the various
antifungal agents is of importance since it influences their ability to penetrate the corneal epithelium. Systemic administration may be necessary for resistant fungal
ulcers. For fungal
endophthalmitis, to preserve visual function and eliminate the fungal pathogen, topical, systemic and possibly intraocular antifungal
therapy is used, although some do not recommend use of systemic agents for exogenous
endophthalmitis.