Fungal corneal ulcer- everything you must know about
A fungal corneal ulcer is one of the most serious eye infections that can lead to permanent vision loss if not treated on time. When fungi invade this layer, they cause painful ulcers that heal very slowly and are difficult to manage. Understanding its symptoms, causes, and treatment options can help save eyesight.
Causative agents
A corneal ulcer is an open wound or sore on the cornea. While bacteria and viruses can also cause corneal ulcers, fungal infections are more dangerous because they respond slowly to treatment. These ulcers are more common in warm and humid climates, especially in people who work outdoors.
The infection usually starts after a minor injury to the eye, especially with plant material, soil, or dust. The most common fungi responsible include:
- Fusarium and Aspergillus (filamentous fungi, often linked to trauma with vegetative matter)
- Candida (yeast-like fungi, more common in people with weak immune systems or existing eye disease)
Risk factors
Other risk factors include:
- Wearing contact lenses for long hours or sleeping in them
- Long-term use of steroid eye drops
- Diabetes or poor immunity
- Previous eye surgery or surface disease
Diagnosis
A fungal corneal ulcer can look different from bacterial ulcers, but some key signs include:
- Red, painful eye that gets worse over days
- Blurred or decreased vision
- White or gray spot on the cornea with feathery edges
- Excessive tearing or discharge
- Sensitivity to light (photophobia)
- In severe cases, pus inside the eye (hypopyon)
An eye specialist usually performs a slit lamp examination to check the cornea. To confirm fungal infection, the doctor may take a corneal scraping for lab testing. Sometimes, advanced imaging like confocal microscopy is used to detect fungal filaments.
Eye Drops (First Line Treatment)
- Natamycin 5%: Best for filamentous fungi like Fusarium.
- Amphotericin B 0.15%: Works well for Candida infections.
- Voriconazole 1%: Broad coverage, especially when other drugs don’t work.
These drops are used very frequently (every hour at first) and require patience, as treatment may last for weeks.
Oral Medicines
If the infection is deep or severe, doctors may prescribe oral antifungal tablets such as Itraconazole or Voriconazole to support healing.
Antifungal Injections in Active Ulcers
When standard drops and tablets are not enough, doctors may give antifungal injections:
- Intrastromal injections: The medicine (usually Voriconazole or Amphotericin B) is injected directly into the corneal stroma around the ulcer. This delivers high drug concentration right where it’s needed.
- Intracameral injections: In severe cases with pus inside the eye, antifungals are injected into the anterior chamber (front part of the eye).
These injections are usually considered in the active stage of the ulcer to control the infection and prevent corneal perforation.
Surgery for Severe Cases
If medicines and injections don’t work, the last option is a therapeutic corneal transplant (penetrating keratoplasty). In this surgery, the infected corneal tissue is replaced with healthy donor tissue.
Can Fungal Corneal Ulcers Be Prevented?
Yes! prevention is possible with a few simple steps:
- Always use protective glasses when working outdoors, especially with plants or soil.
- Avoid sleeping in contact lenses or using them in unclean water.
- Do not use steroid eye drops without medical supervision.
- Get any eye injury checked immediately by an eye specialist.
Final words- fungal corneal ulcer
A fungal corneal ulcer is a vision-threatening eye disease that needs immediate attention. Unlike bacterial ulcers, these infections are stubborn and take longer to heal. Early diagnosis, proper antifungal eye drops, and in some cases injections directly into the cornea or anterior chamber can help save the eye and restore vision.
If you notice a painful red eye that is not improving, consult an ophthalmologist right away. Timely treatment can mean the difference between recovery and permanent vision loss.
Founder of EyesMatterMost- an optometry student who loves talking about eyes. I tend to cover topics related to optometry, ophthalmology, eye health, eyecare, eye cosmetics and everything in between. This website is a medium to educate my readers everything related to eyes.
