A 33 years old male came with pain and watering in the right eye for 36 hours. On examination, a 3 x 2 cm corneal ulcer is seen with elevated margins, feathery hyphae, finger like projections and minimal hypopyon in cornea. What is the likely causative organism?
(A) Aspergillosis (B) Pseudomonas (C) Acanthamoeba (D) HSV-1
(A) Ans: A. AspergillosisRef: Yanoff & Duker 4/e p225; Parson 22/e p203, 21/e p199)Finding suggestive of fungal corneal ulcer. In the question, Aspergillus is the only fungus.Mycotic or fungal keratitis:Commonly due to Aspergillus, Fusarium or Candida albicans.Fungal ulcers are typically seen after injury with vegetable matter such as a thorn or wooden stick and are characterized by a relatively indolent course.Symptoms are much milder than the clinical signs would suggest.Dry slough with feathery borders, surrounded by a yellow line of demarcation, which gradually deepens into a gutter.An immune ring (Wessely) may be visible due to deposition of immune complexes and inflammatory cells around the ulcer.Marked ciliary and conjunctival congestion.Hypopyon is thick and immobile - Due to direct invasion into the anterior chamber of fungal hyphae enmeshed in thick exudates.