How is fungal keratitis in HIV infection treated?

Updated: Jun 12, 2019
  • Author: Robert A Copeland, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Answer

Initially, corneal infiltrates and ulcers are usually treated as bacterial infections until the results of cultures and/or staining are obtained. If cultures indicate fungal keratitis, then the following action is recommended:

  • The patient should be hospitalized, unless very reliable, and started on natamycin 5% (50 mg/mL) drops every 1-2 hours while awake and every 2 hours during the night hours

  • Use a cycloplegic agent (eg, homatropine 5% tid, scopolamine 0.25% tid)

  • Avoid topical steroids

  • Avoid eye patching

For deep stromal infection, combination medication is recommended: topical amphotericin B, topical fumagillin, miconazole or clotrimazole and/or oral fluconazole, itraconazole, or albendazole.


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