A 34-year-old rice paddy farmer presents with a rapidly progressive corneal ulcer. Slit lamp shows a 5 mm stromal infiltrate with feathery edges, satellite lesions, and an immune ring (Wessely ring). Confocal microscopy shows linear branching structures. The MOST effective initial treatment is:
- A Topical moxifloxacin 0.5% hourly
- B Topical voriconazole 1% every hour
- C Topical aciclovir 3% five times daily
- D Topical natamycin 5% every hour ✓
Explanation
Feathery-edged stromal infiltrate with satellite lesions, Wessely immune ring, and branching linear hyphae on confocal microscopy in an agricultural worker is classic for Fusarium or other filamentous fungal keratitis. Natamycin 5% topical is the first-line treatment for filamentous fungi (Fusarium, Aspergillus) because it is a polyene antifungal with excellent activity against these molds and penetrates into corneal stroma. Voriconazole 1% is used for cases resistant to natamycin or for Aspergillus species. Moxifloxacin is a fluoroquinolone antibacterial with no antifungal activity. Aciclovir treats herpes simplex keratitis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.