Demographic Pattern, Risk Factors, Clinical and Microbiological Characteristics of Fungal Keratitis

PURPOSE: To document the clinico-epidemiological features and laboratory diagnosis of fungal corneal ulcer observed at a tertiary referral centre. DESIGN: Prospective descriptive study. SETTING: Department of Ophthalmology Unit III, Eye Hospital, Liaquat University of Medical and Health Sciences Hyderabad, Sindh-Pakistan from April 2007 to March 2010. MATERIAL AND METHODS: Three hundred and fifteen patients of different ages having provisional diagnosis of suppurative corneal ulceration were registered for the study. Data were collected through history and slit lamp examination. Corneal scraping was performed. A portion of each scraping was examined by direct microscopy. Another portion was inoculated directly on to solid culture media. RESULT: Among corneal scraping from 315 patients, the fungus grew in 116 (36.8%). The mean age of patients was 42.6 years (ranged between 9 and 82 years). Majority of patients (80; 68.97%) were between the 3rd and 5th decade of life. Males (72; 62.1%) were affected more often. Majority of the patients (80; 69%) was from rural areas. A majority of (52; 44.80%) patients was farmer by profession. Corneal trauma (70; 60.4%) was identified as the leading precipitating factor. Forty eight (41.4%) patients had corneal injury with vegetative material. The peak incidence observed in the months of October to December followed by March to June. The clinical features were dry, thick and raised grayish white corneal surface in 76 (65.51%) patients, stromal infiltrates with feathery margins in 64 (55.2%) patients, typical satellite lesions in 19 (16.38%) patients, hypopyon was present in 70 (60.3%) patients. Candida albicans was the most frequent organism which was isolated in eighty (69%) patients. CONCLUSION: Fungi were found to be the frequent cause of suppurative corneal ulcer following agriculture trauma and Candida albicans being the most commonly isolated pathogen. For the diagnosis of fungal infection direct microscopic examination with potassium hydroxide 10% is a rapid, inexpensive, and reliable method.