A patient with a history of trauma by vegetable matter develops a corneal ulcer with a feathery margin, satellite lesions, and endothelial plaques. No hypopyon is initially seen. Corneal scraping potassium hydroxide (KOH) preparation is positive. Which organism is most likely and what is the most specific treatment?

• A Candida albicans — treat with topical fluconazole
• B Aspergillus fumigatus — treat with topical voriconazole
• C Nocardia — treat with topical trimethoprim-sulfamethoxazole
• D Fusarium solani — treat with natamycin 5% eye drops ✓

Explanation

Trauma by vegetable matter (soil, plant matter) is the classic predisposing factor for Fusarium keratitis, the most common filamentous fungus causing corneal ulcers in tropical countries (including India). The characteristic features are feathery (hyphate) margins, satellite lesions, and immune endothelial plaques. Natamycin 5% ophthalmic suspension is the only commercially available polyene specifically formulated for topical ophthalmic use and is first-line for Fusarium keratitis. Candida typically occurs in immunocompromised patients with soft lenses rather than vegetable trauma; fluconazole is used. Aspergillus may cause similar features; voriconazole is increasingly used. Nocardia produces a 'wreath' pattern and responds to trimethoprim-sulfamethoxazole.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.