Presumed Ocular Pythium Keratitis

To describe successful treatment of presumed Pythium keratitis with medical therapy alone

Cornea clinic services in tertiary care centre in North India

A 39 years old male presented with a history decreased vision,pain and irritation in right eye for 1month after trivial trauma.On Slit lamp examination,a paracentral crescent shaped dense,dry looking greyish infilterate with surrounding tentacle like projections,peripheral pinhead size suepithelial lesion and guttering.KOH wet mount revealed broad aseptate,ribbon like hyphae characteristic of Pythium species.Confocal imaging revealed beaded,thin hyperreflective hyphae with minimal branching.Based on corroborative evidence,a diagnosis of presmptive pythium keratitis was made.He was administered eye drops linezolid 0.2%1 hourly, azithromycin 1%2 hourly, atropine sulphate thrice daily and oral azithromycin 500 mg once daily for 3 days a week. 

After treatment  pin head sized subepithelial lesions started regressing  by 5 days of  medical therapy. The tentacle like lesion did not worsen.At 6 weeks the tentacle like lesions completely disappeared. At the end of 3 months the patient had healed corneal ulcer with best corrected visual acuity of 20/40.

Presumptive pythium keratitis of  the patient completely resolved with antibacterial treatment alone. It is important for an ophthalmologist to identify non responding fungal corneal ulcer and to corroborate various evidence to suspect pythium keratitis and start early treatment to prevent poor outcome.