SUMMARY Structural changes in the external retinal layers of pigs' eyes that had previously been subjected to blunt non-perforating mechanical injuries have been described. Within minutes of trauma fragmentation of the photoreceptor outer segments and damage to the retinal pigment epithelium was recorded in areas of retina adjacent to the missile impact site on the sclera. One week after injury the disrupted photoreceptor outer segments disappeared, and the inner segments came to lie adjacent to the retinal pigment epithelium. Evidence of regeneration of photoreceptor outer segments was noted 2 weeks later.

The Farnsworth-Munsell

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A case of fungal keratitis caused by Scopulariopsis brevicaulis following a penetrating eye injury is described. Treatment A corneal scrape revealed a few pus cells and later on culture yielded Scopulariopsis brevicaulis, confirming the previous report. An anterior chamber tap showed numerous pus cells but no organisms. Blood cultures were negative. The sensitivities of the organism were not available initially, but it was thought that treatment with amphotericin should be continued.As endophthalmitis was suspected; amphotericin was instilled into the anterior chamber at the time of the tap at a dose of 1-25 ,ig in 0 1 ml. This was calculated as 1/4 of the accepted intravitreal dose.1-' Topical steroids were stopped and hourly amphotericin 0-5% drops and cyclopentolate 1% drops three times a day continued. In addition, intravenous amphotericin 0-25 mg/ kg daily was given. After an initial improvement the hypopyon then increased and the cornea became more cloudy. On microbiological advice a new antifungal drug, itraconazole (Jansen Pharmaceuticals), was added at an initial dose of 200 mg twice a day orally for 24 hours, reducing to a maintenance dose of 100 mg twice a day. The clinical condition deteriorated further, and an emergency keratoplasty (8-5 mm donor button, with removal of an 8-0 mm disc of cornea, including all the involved cornea) was performed. Histological examination confirmed the mycotic keratitis with isolation of Scopulariopsis brevicaulis. Following keratoplasty dexamethasone 0-1% drops four times a day were given and the topical amphotericin 0(5% drops were reduced to four times daily. Intravenous amphotericin was stopped and oral itraconazole continued for three days.The graft cleared and has remained transparent, with a visual acuity of 6/9 with a contact lens. Later the Mycological Reference Laboratory showed the organism was resistant to amphotericin B at 20 [tg/ml but sensitive to itraconazole 2-0 [tg/ml.

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