What are the common types of fungal eye infections. How do fungal eye infections develop. What are the symptoms of fungal keratitis. How is fungal keratitis diagnosed and treated. Can fungal eye infections lead to vision loss. What are the risk factors for developing eyelid infections. How can fungal eye infections be prevented.

Understanding Fungal Keratitis: A Serious Eye Infection

Fungal keratitis is a severe infection of the cornea, the clear, dome-shaped window at the front of the eye. This condition can develop rapidly, often following an eye injury or improper contact lens use. If left untreated, fungal keratitis can lead to blindness, and in some cases, even with treatment, permanent vision impairment may occur.

Various fungi can cause this infection, including:

• Fusarium
• Aspergillus
• Candida

Keratitis, in general, refers to inflammation or infection of the cornea. It can be classified into two main types:

1. Superficial keratitis: Affecting the outer layers of the cornea, usually healing without scarring.
2. Deep keratitis: Involving deeper corneal layers, potentially resulting in scarring that may impact vision depending on its location.

Other Types of Keratitis

While our focus is on fungal keratitis, it’s important to note that other forms of keratitis exist:

• Amoebic keratitis: Caused by amoeba, often affecting contact lens wearers
• Bacterial keratitis: Resulting from bacterial infections
• Herpes keratitis: Caused by herpes simplex or herpes zoster viruses
• Photokeratitis: Due to intense UV radiation exposure, such as snow blindness or welder’s arc eye

Causes and Risk Factors of Fungal Keratitis

Fungal keratitis typically occurs when the cornea is injured, especially by plant material. For instance, being hit in the eye with a palm branch can introduce fungi like Fusaria, which are common in soil, water, and plants, particularly in warmer climates.

Individuals with compromised immune systems are at higher risk of developing fungal keratitis if they come into contact with the causative fungi. Contact lens wearers also face an increased risk, emphasizing the importance of proper lens care and hygiene.

Are certain environments more conducive to fungal eye infections?

Yes, warmer and more humid climates tend to have a higher prevalence of fungi that can cause eye infections. Additionally, environments with a lot of plant material or organic debris can increase the risk of exposure to potential fungal pathogens.

Recognizing the Symptoms of Fungal Keratitis

Early detection of fungal keratitis is crucial for preventing vision loss. The following symptoms may indicate a fungal eye infection:

• Sudden reduction in vision
• Acute eye pain
• Increased sensitivity to light
• Excessive tearing
• Unusual discharge from the eye

It’s imperative to seek immediate medical attention if you experience any of these symptoms, especially if they occur suddenly. Prompt treatment is essential to prevent potential blindness.

How quickly can fungal keratitis progress?

Fungal keratitis can progress rapidly, sometimes within days. The speed of progression underscores the importance of seeking medical attention at the first sign of symptoms to prevent serious complications.

Diagnosis and Treatment of Fungal Keratitis

Diagnosing fungal keratitis involves a careful examination by an ophthalmologist. They may gently scrape the eye to collect a small sample for testing, which helps differentiate between fungal and bacterial keratitis.

Treatment typically includes:

1. Antifungal eye drops
2. Oral antifungal medications
3. In severe cases, surgical intervention, including corneal transplantation

It’s important to note that even with aggressive treatment, some cases of fungal keratitis may result in permanent vision impairment or blindness. This underscores the critical nature of early detection and treatment.

What is the success rate of treating fungal keratitis?

The success rate of treating fungal keratitis varies depending on factors such as the causative organism, the extent of infection, and how quickly treatment is initiated. Early diagnosis and appropriate treatment significantly improve outcomes, but some cases may still result in vision loss despite best efforts.

Eyelid Infections: A Related Concern

While distinct from fungal keratitis, eyelid infections are another important eye health issue to be aware of. These infections occur when glands along the lash line become clogged or irritated, usually due to bacterial causes.

Certain skin conditions can increase the risk of eyelid infections:

• Eczema
• Dandruff
• Psoriasis

These conditions can trigger eyelid inflammation (blepharitis), which, if left untreated, may lead to infection.

Can eyelid infections lead to more serious eye problems?

Yes, untreated eyelid infections can potentially spread to other parts of the eye or surrounding tissues. In some cases, they may lead to more serious conditions like orbital cellulitis. This is why prompt medical attention for any eye-related symptoms is crucial.

Identifying Eyelid Infection Symptoms

Recognizing the signs of an eyelid infection is crucial for seeking timely treatment. Common symptoms include:

• Redness in and around the eyes
• Crusty debris along the eyelids
• Burning or itching sensation
• Swelling of the eyelids
• Excessive tearing
• Eyelashes sticking together

If you experience any of these symptoms, it’s important to consult an eye care professional promptly to prevent potential complications.

How can you differentiate between an eyelid infection and allergies?

While some symptoms may overlap, eyelid infections typically involve more localized swelling, redness, and discharge. Allergies often affect both eyes simultaneously and may be accompanied by other allergy symptoms like sneezing or a runny nose. When in doubt, it’s best to consult an eye care professional for an accurate diagnosis.

Causes and Risk Factors for Eyelid Infections

Eyelid infections can occur when bacteria are transferred to the eyelids from various sources:

• Existing eye infections, such as conjunctivitis (pink eye)
• Orbital cellulitis
• Trauma to the eye area

Several factors can increase the risk of developing an eyelid infection:

1. Poor hygiene practices, especially in relation to eye care
2. Weakened immune system
3. Chronic skin conditions affecting the face
4. Frequent rubbing of the eyes
5. Improper use or care of contact lenses

Does age play a role in susceptibility to eyelid infections?

While eyelid infections can occur at any age, certain age groups may be more susceptible. For instance, young children may be at higher risk due to frequent eye-rubbing and less developed hygiene practices. Older adults might also face increased risk due to age-related changes in tear production and eyelid structure.

Prevention Strategies for Fungal Eye Infections and Eyelid Infections

Preventing fungal eye infections and eyelid infections involves several key practices:

• Maintain proper hand hygiene, especially before touching your eyes
• Use and care for contact lenses as directed by your eye care professional
• Avoid sharing personal items that come into contact with your eyes, such as makeup or towels
• Protect your eyes from injury, particularly when working with plants or in environments with airborne debris
• Manage underlying skin conditions that may increase your risk of eyelid infections
• Remove eye makeup thoroughly before sleeping
• Replace eye makeup regularly to prevent bacterial growth

By following these preventive measures, you can significantly reduce your risk of developing fungal eye infections and eyelid infections.

Are there specific dietary or lifestyle choices that can help prevent eye infections?

While no specific diet can prevent eye infections, maintaining overall health through a balanced diet rich in vitamins A, C, and E may support eye health. Staying hydrated, getting adequate sleep, and managing stress can also contribute to a stronger immune system, potentially reducing the risk of infections. However, these measures should complement, not replace, proper eye hygiene and care practices.

When to Seek Medical Attention for Eye Concerns

It’s crucial to seek immediate medical attention if you experience any of the following:

• Sudden changes in vision
• Severe eye pain
• Significant redness or swelling of the eye or eyelid
• Persistent discharge from the eye
• Increased sensitivity to light
• Any symptoms following an eye injury

Remember, early intervention is key in preventing serious complications from eye infections. Don’t hesitate to consult an eye care professional if you have any concerns about your eye health.

What should you do while waiting for a medical appointment if you suspect an eye infection?

While waiting to see a healthcare provider, avoid touching or rubbing your eyes to prevent further irritation or spread of infection. You can use a clean, warm compress to provide some relief, but avoid applying any over-the-counter eye drops or ointments without professional advice, as these may interfere with diagnosis or potentially worsen the condition.

What is Fungal Keratitis? – American Academy of Ophthalmology

Fungal keratitis is an infection of the cornea. The cornea is the clear, dome-shaped window of the front of your eye and focuses light into your eye. Fungal keratitis can develop quickly from an eye injury or contact lens use. It can cause blindness if it is not treated. In some cases, treatment cannot restore vision. In these cases, permanent vision impairment or blindness may occur.

There are many different fungi that can infect the cornea such as Fusarium, Aspergillus or Candida.

Keratitis. Keratitis is an infection or inflammation of the cornea.

Superficial keratitis involves the outer layers of the cornea. After this form of keratitis heals, there is usually no scar on the cornea.

Deep keratitis affects deeper layers of the cornea. There can be a scar on the cornea after it heals, which may or may not affect your vision. This will depend on the location of the scar.

Besides fungal keratitis, other types of keratitis include:

• amoebic keratitis, which is an infection with amoeba. It is often caused by Acanthamoeba and usually affects contact lens wearers.
• bacterial keratitis, which is an infection with bacteria
• herpes keratitis, which is an infection with herpes simplex or herpes zoster viruses
• photokeratitis, due to intense ultraviolet (UV) radiation exposure. Examples include snow blindness or welder’s arc eye.

Fungal Keratitis Causes

Fusaria are common fungi found in soil, water, and plants throughout the world. They are particularly common in warmer climates. Fungal keratitis can happen after an injury to the cornea involving plant material. One example is getting hit in the eye with a palm branch.

People who have a low immune response can also get fungal keratitis if they come in contact with the fungus. There is also a risk of developing fungal keratitis with contact lens use. Proper use and care of contact lenses can reduce your risk of getting a fungal infection if you wear contacts. Ask your ophthalmologist about proper contact lens care.

Fungal Keratitis Symptoms

Symptoms of fungal keratitis may include:

• reduced vision
• pain in the eye (often sudden)
• increased light sensitivity
• tearing
• excessive tearing or discharge from your eye 

Call your ophthalmologist right away if you experience any of these symptoms. This is especially important if these symptoms come on suddenly. You must start treatment right away to prevent possible blindness.

Fungal Keratitis Treatment

Your ophthalmologist may gently scrape the eye to take a small sample of material. They will test the sample for infection. This test will help diagnose whether your infection is fungal keratitis or bacterial keratitis.

Treatment of fungal keratitis usually includes antifungal eye drops and oral medications. If these medicines are not effective, you may need surgery, including corneal transplantation. In some cases, even corneal surgery will not restore vision. In these cases, permanent vision impairment or blindness may occur. That is why it is so important to see your ophthalmologist at the first sign of any ocular infection.

Eyelid Infection: Types and Treatment

By Anna Barden; reviewed by Gary Heiting, OD

• Causes of eyelid infections
• Eyelid infection symptoms
• Types of eyelid infections
• Risk factors
• Diagnosis
• Treatment
• Prevention

An eyelid infection occurs when a gland along the lash line becomes clogged or irritated. In most cases, eyelid infections are caused by bacteria.

Skin conditions such as eczema, dandruff and psoriasis can trigger eyelid inflammation (blepharitis), which can lead to infection if left untreated. Eyelid inflammation is also commonly experienced with any eyelid infection, but typically heals as the infection is treated.

If you think you have an eyelid infection, it is critical to see an eye doctor as soon as possible for an exam and to receive proper treatment.

Causes of eyelid infections

Eyelid infections can occur when bacteria are transferred to the eyelids from:

• Eye infections, such as conjunctivitis (pink eye)

• Orbital cellulitis

• Trauma to the eye area

Eyelid infection symptoms

An eyelid infection will likely involve one or more of the following symptoms:

• Red eyes

• Crusty debris along the eyelids

• Burning or itchiness

• Swelling around the eyelid

• Watery eyes

• Eyelashes sticking together

• Feeling as though something is stuck in your eye

• Light sensitivity (photophobia)

Symptoms may vary depending on what caused the eyelid infection. Consult your eye doctor as soon as you start experiencing any of the above symptoms (or any additional symptoms) so the right treatment can start as soon as possible.

SEE MORE: Swollen eyelids: Symptoms and causes

Types of eyelid infections

In addition to a clogged oil gland in the eyelid, eyelid infections can develop from bacteria, fungi or viruses. 

Bacterial eyelid infection

Poor eye hygiene, using dated cosmetics or a case of pink eye that spreads can cause a bacterial infection in the eyelid. Bacteria can also be transferred to the eyelid in the event of an injury.

A condition called periorbital cellulitis, which is caused by bacteria that attacks the soft tissue around the eye, can also infect eyelids. Periorbital cellulitis usually develops due to a sinus infection that spreads to the eye, but it can sometimes develop after eye trauma.

SEE MORE: Orbital cellulitis

Fungal eyelid infection

A fungal infection can occur on the eyelid if your eyes are exposed to fungal spores in the environment. Eye injuries caused by organic material, such as a branch or thorn, can transmit fungi into the eyes and cause an infection that affects the eyelid.

Viral eyelid infection

A virus such as a cold, flu or COVID-19 can cause eyelid inflammation and lead to an infection. While some symptoms can be managed, there is no treatment to get rid of an eyelid infection caused by a virus; they must simply run their course — typically lasting seven to 10 days (depending on the severity).

Stye

A stye is an infection in the eyelid that causes a pimple-like, painful bump to develop on the corner or edge of the eyelid. They are usually caused by infected or clogged oil glands that run along the eyelashes. 

You can treat a mild stye at home with a warm compress and by gently washing the area with an eye-safe cleanser. However, some styes can lead to a more severe eyelid infection. 

Medical intervention may be needed for severe or persistent styes so that they heal properly and to prevent the infection from spreading.

Chalazion vs. stye

A chalazion is similar to a stye, as they are both small bumps caused by clogged oil glands in the eyelid. Unlike styes, chalazions are bumps located in the middle of the eyelid (rather than at the lid margin) and are painless. 

Risk factors

Certain issues and bad habits may elevate the risk of an eyelid infection, including:

• Poor eye hygiene

• Dated or shared cosmetics, facial cleansers or contact solutions

• Wearing expired contact lenses

• Allergies to environmental factors or to certain cosmetics

• Chronic blepharitis (eyelid inflammation) 

• Dry eye syndrome

• Skin conditions such as dandruff, psoriasis and eczema

Proper eye hygiene and management of underlying conditions can help prevent eyelid infections. 

Important to remember: Always check the expiration date or shelf life of your contact lenses as well as cosmetics, and avoid sharing eye makeup with others.

SEE RELATED: Tips for contact lens wearers

Diagnosis

An eye doctor can diagnose an eyelid infection by closely examining your eyes and eyelids. 

In some cases, a swab of your eyelid margin will likely also be taken and sent to a lab to determine the type of bacteria. This information is important to determine the right treatment plan.

It is critical to see an eye doctor as soon as you begin to experience symptoms of an eyelid infection, as treatment depends on the underlying cause.

Treatment

Stop wearing contact lenses and keep the area as clean as possible with an eye-safe cleanser at the first sign of an infection. After examining your affected eye(s), your eye doctor will recommend a specific treatment plan based on the underlying condition.

Warm compress

Mild cases of eyelid infections, such as a stye, can be treated at home with a warm compress. Over-the-counter pain relievers, such as ibuprofen, may be taken to help with discomfort and inflammation.

Medicated eye drops and ointment

Bacterial eyelid infections are usually treated with antibiotic eye drops or ointment. Oral antibiotics may also be used, depending on the condition.

Fungal eyelid infections are typically treated with prescribed antifungal eye drops or pills. These infections take longer to heal, and medication may be prescribed for several weeks. 

Can you treat viral eyelid infections?

Like other viral infections, viral eyelid infections are not treatable with antibiotics. Other treatment for viral eyelid infections is minimal, though pain can be managed with a warm or cool compress and over-the-counter eye drops and/or pain relievers.

Prevention

If you experience a condition that causes chronic eyelid inflammation, your eye doctor may suggest a vitamin regimen to promote eye health after the infection heals. 

Certain skin conditions and other medical problems can make you more prone to eyelid infections, but with the proper management of these conditions, your risk may be lowered.

Always contact an eye doctor if you experience signs or symptoms of an infection anywhere on, in or near your eye, and stay up to date with annual eye exams for optimal eye health.

Page published on Thursday, May 27, 2021

Medically reviewed on Saturday, April 24, 2021

Fungal infections of the eyes

Ophthalmomycosis | Keratomycosis

Fungal infections of the eyes

Fungal infections of the organ of vision have been known for over 100 years. For a long time, this pathology was considered very rare, the types of fungi dangerous to the eyes were counted in units, publications about the diseases they cause were mostly casuistic.

However, since the 1950s, reports of such diseases have become more frequent. Quite often, a significant number of observations are given, previously unknown ones are described.0009 fungal infections of the eyes and representatives of the fungal flora that cause them new to ophthalmologists.

The clinic, diagnosis and prevention of fungal eye infections are being specified, more effective methods of treating ophthalmomycosis are offered.

Currently, up to 50 species of fungi are considered pathogenic for the organ of vision. The most important of them are yeast-like, moldy mycetes, dermatophytes, etc.

In the majority of patients with ophthalmomycoses, fungi penetrate into the tissues of the eye from the environment or are introduced from mycotic foci on the skin and mucous membranes of other parts of the body, less often they come from such and deeper sources by the hematogenous route.

Exogenous infection with fungi usually causes mycoses of the appendages and anterior part of the eyeball. Endogenous drift often causes severe intraocular processes.

Of great importance in the inoculation of a fungal infection in the tissue of the eyelids, conjunctiva and eyeball are damage to the latter, often small abrasions and erosion, superficial foreign bodies of the conjunctiva and cornea, especially derivatives of the plant world.

For example, out of 33 observed by F. M. Polack et al. (1971) patients with keratomycosis only 4 had no history of eye damage. Fungi penetrate inside the eye with perforated wounds. More often than others, ophthalmomycosis affects rural residents, workers in elevators, granaries, mills, cotton gins, weaving mills, feed mills, livestock breeders, etc.

Fungal diseases occur more easily and proceed worse, especially in early childhood, when the body is weakened due to general infections, malnutrition, and metabolic disorders. For such patients, even the most harmless fungi, human saprophytes, become pathogenic.

Unlike infectious eye diseases of bacterial and viral origin, drug therapy is ineffective in fungal diseases. All authors unanimously recognize the wide, not always rational, local and general use of antibiotics and corticosteroids for the treatment of various human diseases as one of the important reasons for the growth of fungal eye diseases in recent decades.

The validity of this opinion is confirmed by clinical observations and experimental studies. So, H. V. Nema et al. (1968) after a month’s treatment of the conjunctiva found previously absent fungal flora in the conjunctival sac in 41.2% of patients treated with hydrocortisone and in 28.7% of patients treated with tetracycline. Similar data are given by L. Nollimson et al. (1972) for betamethasone and neomycin. According to I. I. Merkulov, antibiotics violate the antagonistic relationship between bacteria and fungi in favor of the latter, and corticosteroids reduce the protective ability of tissues. In addition, some fungi, notably Candida albicans and Aspergillus niger, grow better and become more pathogenic in the presence of corticosteroids. The growth of fungi, especially Candida albicans, is also promoted by B vitamins.

The noted features of a fungal infection are characteristic not only of eye processes; they appear in many other localizations of mycoses. Nevertheless, it is important for ophthalmologists that the organ of vision is no exception to the general patterns of human fungal infections. If a patient seeking eye care developed an inflammatory disease of the eye against the background of mycosis of other parts of the body, the disease was preceded by even a minor injury, according to the conditions of life and work, the patient could become infected with a fungal infection, and an attempt to treat with antibiotics, sulfonamides, corticosteroids was unsuccessful, then there is every reason suspect ophthalmomycosis .

In cases where the clinical picture of eye disease has signs characteristic of a fungal infection, the above factors are additional data. However, to establish an accurate diagnosis of ophthalmic mycosis , it is necessary to isolate the fungus culture, determine its type, confirm that it was this pathogen that caused the eye disease in this patient, and clarify the sensitivity of the isolated culture to antimycotic agents. Quick and unambiguous answers to the questions posed can not always be obtained.

In wide practice, the etiology of an eye disease is often assessed as mycological only on the basis of anamnestic data, the clinical picture of the eye process, the detection of extraocular foci of mycosis, and trial treatment with antimycotic agents. Naturally, with this approach, part of ophthalmomycosis , especially when layered on viral and bacterial eye diseases, remains unrecognized. It is advisable to resort to laboratory mycological studies in case of suspicion of ophthalmomycosis as often as possible.

Despite the variety of pathogens and manifestations of fungal infections of the eye, their clinic is characterized by some common qualities.

Thus, the incubation period from the time of the introduction of a fungal infection to the appearance of the first signs of eye disease ranges from 10 hours to 3 weeks. Symptoms tend to develop slowly, and the process is often chronic without a tendency to spontaneous remission.

There are always external manifestations of inflammation expressed in varying degrees:

• hyperemia,
• purulent discharge,
• tissue infiltration and ulceration,
• Delayed defect repair.

A number of fungal invasions of the eye are inherent

• formation of granuloma-like nodules in the skin of the eyelids, conjunctiva, orbit, vascular tract,
• their suppuration with the occurrence of fistulas, skin bridges,
• the presence of grains from the mycelium of the fungus in the discharge,
• formation of calculi in lacrimal ducts and conjunctival glands,
• crumbly character of infiltrates,
• their yellowish or greyish-yellow color, etc.

At the same time, most fungal infections of the eye are characterized by individual differences, depending on the type of fungi, localization and prevalence of the lesion, the condition of the tissues preceding mycosis, general health, body reactivity, even hereditary predisposition to fungal diseases. The first group of signs facilitates the general diagnosis of mycosis of the eye, the second helps to suspect a certain type of fungus, which is important when choosing methods and means of treatment.

Histologically, in preparations and sections of eye tissues affected by fungi, violations of the integrity of the epithelium and perforation of its cells, nonspecific granulomas of leukocytes, lymphocytes, histiocytes, epithelioid and other cells, pskrobio.ch and dystrophic changes around such granulomas are determined.

With the help of special stains (methods of Gridl, Gomori, etc.) in such preparations, as well as in scrapings from conjunctival and cornea ulcers, mycelium and spores of the pathogen are often detected. Some types of fungi, such as Candida albicans, cause only leukocyte and eosinophilic infiltration of the membranes and suppuration of the internal ones; environment of the eyeball.

Fungal pathology of the eye and its auxiliary apparatus is caused not only by the direct introduction of pathogens into their tissues.

It often develops as an allergic reaction to fungal allergens coming from mycotic foci distant from the eye. With persistent eye processes that have not been cured for years, such foci are found under the crowns and bridges of the teeth in the oral cavity, in the interdigital folds of the legs, and in the vagina. Sometimes the cause of allergies was onychomycosis. A pronounced reaction to trichophytosis (skin test) and a quick recovery of the eyes after the elimination of extraocular foci are strong evidence of the allergic nature of this pathology.

Treatment of fungal diseases of the organ of vision

The treatment of human fungal diseases in general is currently carried out primarily with special antimycotic agents, the arsenal of which is significant, and the effectiveness is quite high.

Timely started and carried out purposefully selected in accordance with the clinical data and characteristics of isolated cultures of pathogens therapy is the most successful. More often than other means of such therapy in general mycology, antifungal antibiotics are resorted to: nystatin, which is active against yeast-like and mold fungi, amphotericin B and amphoglucocamine, which affects the pathogens of coccidioidomycosis, cryptococcosis, blastomycosis, mold and other fungi, levorin, which affects fungi of the genus Candida, griseofulvin, effective for epidermophytosis, trichophytosis, microsporia. Of the other fungicides acting on fungi, they are used, mainly in dermatology, decamin and decamethoxin, useful for candidomycosis, nitrofurilen, nitrofran, esulan, amikazol, Zinkundan ointments. “Undecin” and a number of other drugs.

When prescribing general treatment with fupgicides, one should be strictly guided by the said manual, since many of these drugs, especially amphotericin B, griseofulvin, and others, are characterized by increased toxicity. There are many contraindications to their appointment, they require compliance with a number of conditions for their use. Ophthalmic forms of fupgistatics for topical use are: eye drops (0.25%, 0.5% and 1%) and eye ointment (0.5%) amphotericia B, eye drops (1% and 2.5%) and eye ointment (2.5%) levorin, eye drops (1%), solution for injection under the conjunctiva (1-2.5%)) and eye ointment (5%) nystatin. Prescription solution for injection under the conjunctiva of amphotericin B (0.015 g in 0.2 ml of water), eye drops of grisemin (0.5%) and dekamin (0.1%) are given in the reference book on ophthalmology, published in 1967 g. Using the recipes given in these reference books, ophthalmologists have the opportunity to supplement the general treatment of ophthalmomycosis with the local appointment of the most effective antifungal agents, sometimes limiting themselves to local treatment, and also use these agents to sanitize the conjunctival cavity from fungal flora. The electrophoresis of antifungal drugs has been successfully tested in ophthalmology.

In the treatment of certain types of fungal infections of the organ of vision, iodine preparations, aniline dyes, and disinfectants that have been used for a long time have not lost their value. Often, surgical interventions from simple curettage of foci and opening of abscesses to keratoplasty and vitreectomy give good results.

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