A 48-year-old diabetic with orbital cellulitis presented with a corneal ulcer. An aqueous tap showed branched hyphae. Diagnosis is -
Mycotic (fungal) corneal ulcer The incidence of corneal ulceration due to fungi has increased significantly due to long-term unwarranted use of antibiotic and steroid.
The most common mode of infection is an injury by vegetative material such as crop leaf, horn, wooden stick.
The causative fungus is Aspergillus fumigatus (most common), Candida albicans and fusarium. Clinical features 

Symptoms are similar to bacterial corneal ulcers but in general, they are less marked than the equal size bacterial ulcer.

On the other hand, signs are very prominent, i.e. signs are more prominent than symptoms,

Following signs can be seen: -

i) Greyish-white dry looking ulcer with the elevated rolled out feathery & hyphate margins.
ii) Feathery finger-like extension into surrounding stroma under intact epithelium.
iii) A sterile immune ring (yellow line) of Wesseley.
iv) Multiple small satellite lesions.
v) Non-sterile (infected) hypopyon (Pseudohypopyon-Hence penetrated the endothelium)
vi) Perforation is rare and comes vascularization is conspicuously absent. Diagnosis o Examination of wet KOH will show:-
i) Filamentous fungi (branched septate hyphae ):- Aspergillus fumigatus, Fusarium.
ii) Non-filamentous (yeast-like fungi): - Candida. Treatment of fungal corneal ulcer  Treatment of corneal fungal ulcer involves:-
1) Specific (definitive) treatment, and
2) Adjunctive (concurrent) treatment.
1) Definitive treatment: - It includes antifungal drugs: -
A) Topical antifungals -
i) For filamentous fungi (Aspergillus, Fusarium):- Natamycin (5%) eye drops (drug of choice), Miconazole ointment, Amphotericin B drops.
ii) For yeast (Candida): - Amphotericin B (Drug of choice), nystatin, flucytosine.
B) Systemic antifungals: - May be required in severe cases. Fluconazole or ketoconazole may be used.
2) Adjunctive/Concurrent therapy: - This follows the same principles as in any other infectious corneal diseases. Cycloplegic (1% atropine ointment or drop is the DOC) should be used to: -
i) Reduce pain from ciliary spasm;
ii) Prevent posterior synechiae;
iii) Reduce uveal inflammation.  Topical steroids enhance fungal replication and corneal invasion and are contraindicated during early therapy of a fungal corneal ulcer.
Herpetic ulcer
Mycotic Ulcer
Bacterial Ulcer
Anterior staphyloma