Topical Corticosteroids and Fungal Keratitis: A Review of the Literature and Case Series

Abstract

The management of fungal keratitis is complex since signs and symptoms are subtle and ocular inflammation is minimal in the preliminary stages of infection. Initial misdiagnosis of the condition and consequent management of inflammation with corticosteroids is a frequent occurrence. Topical steroid use is considered to be a principal factor for development of fungal keratitis. In this review, we assess the studies that have reported outcomes of fungal keratitis in patients receiving steroids prior to diagnosis. We also assess the possible rebound effect present when steroids are abruptly discontinued and the clinical characteristics of three patients in this particular clinical scenario. Previous reports and the three clinical descriptions presented suggest that in fungal keratitis, discontinuing topical steroids can induce worsening of clinical signs. In these cases, we recommend to slowly taper steroids and continue or commence appropriate antifungal therapy.

Postoperative Fungal Keratitis Managed by Anterior Chamber Washout and Intracameral Amphotericin-B: A Report of Two Cases

“…Prolonged usage of topical steroids can worsen fungal keratitis and disturb the normal flora of the eye and local immunosuppression. The immunosuppression caused by topical corticosteroids is associated with the expansion of the infectious process in the corneal stroma and endothelium [ 8 ]. Numerous studies have concluded that the usage of topical steroids in the treatment of fungal keratitis resulted in detrimental effects and urged physicians to discontinue topical steroids in cases of suspected or culture-proven fungal keratitis [ 8 ].…”

“…The immunosuppression caused by topical corticosteroids is associated with the expansion of the infectious process in the corneal stroma and endothelium [ 8 ]. Numerous studies have concluded that the usage of topical steroids in the treatment of fungal keratitis resulted in detrimental effects and urged physicians to discontinue topical steroids in cases of suspected or culture-proven fungal keratitis [ 8 ]. Hence, topical steroids were discontinued in both our patients once fungal keratitis was suspected.…”

Suture-Related Fungal Interstitial Interface Keratitis in Deep Anterior Lamellar Keratoplasty: A Case Report

“…The medical therapy could be changed according to clinical response and microbiological findings on its growth and sensitivity. Steroid therapy has always been controversial in infectious keratitis and generally contraindicated in fungal infection [ 15 , 16 ]. Other non-steroidal immunomodulators should be considered in fungal IIK for the benefit of graft protection from inflammatory damage or subsequent rejection [ 17 ].…”

Antifungal Susceptibility Testing and the Ticking Clock

“…8 With the overt empirical use of antifungals (especially, since the rise in prevalence of Post-COVID Mucormycosis), increased lifespan due to better healthcare services, declining mortality, rising morbidity, increased use of steroids, and rise in the prevalence of organ transplants, the need of the hour is availability of Antifungal Susceptibility Testing (AFST) at all the tertiary care settings, which is a prerequisite for better diagnostics and thus, improved therapeutic management. [9][10][11] AFST and identification of fungi, including yeasts, needs to become a routine to avoid the situation we are facing with the bacterial isolates, which have so far developed resistance to all the first line and most of the second line antimicrobials. 12 Also, the alternative antimicrobials and the drugs in the pipeline are also quite restricted, and anticipate restricted hopes.…”