Fungal conjunctivitis is ophthalmomycosis characterized by subacute or chronic inflammation of the conjunctiva caused by pathogenic fungi. Depending on the type of pathogen, fungal conjunctivitis can occur with catarrhal or purulent inflammation, the formation of films or nodular infiltrates on the mucous membrane of the eyes; often the disease takes the form of keratoconjunctivitis. The main method of diagnosis is laboratory determination of the fungus in a smear from the conjunctiva, scraping, separated conjunctival cavity. With fungal conjunctivitis, long-term systemic and local treatment with fungicidal and fungistatic drugs is carried out.
Fungal conjunctivitis is a group of conjunctival mycoses that can be caused by various types of pathogenic fungi that live on the eyelids, in the conjunctival sac, lacrimal tracts or entering the mucous membrane of the eye from the outside. In ophthalmology, fungal conjunctivitis is often combined with fungal blepharitis and keratitis. Keratoconjunctivitis of fungal etiology is characterized by a persistent course, can lead to perforation of the cornea and death of the eye.
According to the clinical form, granulomatous and exudative fungal conjunctivitis are distinguished. Granulomatous form most often develops with sporotrichosis, actinomycosis, rhinosporodiosis, coccidiosis, etc.; exudative form – with aspergillosis and candidiasis.
Fungi, like the microflora of the conjunctival cavity, which does not cause inflammation, are found quite often – in 6.6-27.9% of adults. About 50 species of fungi are considered pathogenic to the eyes.
The direct causative agents of granulomatous fungal conjunctivitis are parasitic fungi of the genus Pennicillium viridans, Coccidioides immitis, Sporotrichum, Actinomicetes. Exudative fungal conjunctivitis is caused by yeast-like fungi of the genus Candida albicans and Aspergillus. The sources of infection can be soil, water, herbs, sick people and animals.
Getting a fungal infection on the conjunctiva is facilitated by mucosal microtrauma, radiation burns of the eyes, mycotic blepharitis, the use of contact lenses in violation of the rules of storage and wearing. Patients with diabetes mellitus, dental caries, mycoses of the skin, long-term receiving glucocorticosteroids or antibiotics, persons with immunodeficiency (especially HIV infection) have an increased risk of developing fungal conjunctivitis. Of the exogenous factors, the warm season, high humidity, dustiness, unfavorable sanitary and hygienic conditions are of the greatest importance.
With fungal conjunctivitis caused by sporotrichosis, rhinosporidosis, actinomycosis, against the background of edema and hyperemia of the conjunctiva, granulomatous growths, granular inclusions, infarctions of the meibomian glands appear. With actinomycosis, the inflammation is catarrhal or purulent; with softening, nodular infiltrates are opened with the release of pus and the formation of long-term non-healing fistulas.
Fungal conjunctivitis, which develops with coccidiomycosis, proceeds with the appearance of flycten-like nodules; conjunctival lesion with the fungus Pennicillium viridans, is accompanied by the formation of superficial conjunctival ulcers covered with a greenish coating.
With granulomatous fungal conjunctivitis, purulent lymphadenitis often develops, fungal micelles are determined in the purulent contents of lymph nodes.
With candidamycosis, pseudomembranes are formed in the conjunctival cavity – grayish or yellowish easily removable films. With aspergillosis, conjunctivitis occurs with infiltration and hyperemia of the conjunctiva, the formation of papillary growths prone to ulceration; it is often combined with a fungal lesion of the cornea – mycotic keratitis. Aspergillosis is sometimes mistaken for suppurated chalazion or barley.
Fungal conjunctivitis is characterized by poor clinical symptoms, an insignificant amount of discharge from the eyes, a long (more than 7-10 days) course, and the ineffectiveness of antibiotic therapy. Prolonged course can lead to deformation of the edges and inversion of the eyelids. Complications of fungal conjunctivitis can be corneal lesions, canaliculitis, dacryocystitis.
Recognition is carried out by an ophthalmologist based on examination data and laboratory identification of the pathogen. In addition to external signs, conjunctival mycosis may indicate an aggravation of symptoms during treatment with antibiotics or glucocorticoids.
The detection of fungi is carried out by microscopic and cytological examination of scraping from the conjunctiva, bacteriological seeding of the separated on nutrient media. If necessary, a consultation with a dermatologist (mycologist), a study of scraping for pathogenic fungi from smooth skin is carried out.
Differential diagnosis is carried out with conjunctivitis of other etiologies: bacterial, viral, allergic conjunctivitis and keratitis.
Therapy of fungal conjunctivitis requires local and systemic use of special antimycotic agents. Locally, in the conjunctival cavity, instillations of solutions of amphotericin B, natamycin, nystatin are prescribed; nystatin ointment is laid overnight behind the eyelids. Fungicidal and fungistatic agents (eye drops and ointments) are manufactured extemporally.
For systemic therapy, one of the antifungal drugs is used: fluconazole, intraconazole, etc.; with extensive ophthalmomycosis, intravenous drip administration of amphotericin B is indicated.
Treatment of fungal conjunctivitis is carried out for 4-6 weeks under the supervision of an ophthalmologist. After the onset of clinical recovery, smears from the conjunctiva are repeatedly performed. Only negative clinical and laboratory data can guarantee that fungal conjunctivitis will not go into a latent form.
Prognosis and prevention
With an isolated course of fungal conjunctivitis, the prognosis is favorable in most cases. With irrational or untimely therapy, the lesion can capture the eyelids, tear ducts, cornea and other structures of the organ of vision.
Prevention of fungal conjunctivitis requires rational treatment of common skin diseases and mycoses, proper care of contact lenses, improvement of hygienic conditions at work and at home, rational administration of antibacterial agents and glucocorticosteroids.