This review article highlights the newer diagnostic modalities and approaches in the medical management of infectious keratitis. A Medline literature search conducted to March 2014 has been included. Recent studies or publications were selected from international indexed journals using suitable key words. Development of specular microscopy and polymerase chain reaction (PCR) has a promising role as diagnostic modalities in infectious keratitis, especially in refractory cases. Previously fortified antibiotics have been the mainstay of treatment for bacterial keratitis. Recently, the advent of fourth-generation fluoroquinolones monotherapy has shown promising results in the management of bacterial keratitis. Corneal collagen cross-linking is being considered in the refractory cases. Topical natamycin and amphotericin B should be considered as the first choice anti-fungal agents in suspected filamentous or yeast infection respectively. Voriconazole and newer routes of administration such as intrastromal and intracameral injection of conventional anti-fungal agents have demonstrated a positive clinical response. Ganciclovir is a newer anti-viral agent with promising results in herpes simplex keratitis. Thus, introduction of newer diagnostic modalities and collagen cross-linking along with fourth-generation fluoroquinolones and newer azoles have a promising role in the management of infectious keratitis.
<p>Invasive sino-orbito-cerebral aspergillosis is rarely seen in immunocompetent individuals; diagnosis and management of which is still a challenge. We report a case of invasive sino-orbito-cerebral aspergillosis in a 38 year immunocompetent male presenting with mild protrusion of right eye which was associated with no other complaint. His visual acuity was 6/6 in both eyes. There was mild proptosis of right eye of 2 mm on Hertel exophthalmometer with no restriction of the ocular movements. MRI brain, orbit and paranasal sinuses revealed soft tissue swelling in right ethmoid, frontal and sphenoidal air cells and orbit with bony destruction of lamina papyracea with intracranial extension of the mass with destruction of lamina cribrosa. The tissue biopsy was taken from the uncinate process and middle turbinate and sent for histopathological examination which revealed a fibrocollagenous soft tissue which was densely infiltrated by inflammatory cells with presence of large number of foreign body granulomas and filamentous aspergillus fungal hyphae. By radiological and histopathological findings, patient was diagnosed as a case of rhino-orbito-cerebral aspergillosis and given Tb Voriconazole 200 mg BD for 6 months after neurosurgery consultation. His proptosis was revealed at 3 months and repeat MRI showed slightly thickened mucosa of sinuses with no mass lesion seen in the orbit and brain with no evidence of any residual fungal granuloma. Orbital aspergillosis is quite challenging in terms of both diagnosis and treatment. Prolonged antifungal therapy is very effective in controlling infection, if patient is compliant.</p>
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