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Viral keratouveitis misdiagnosed as keratomycosis on in vivo confocal microscopy

Poster Details

First Author: C.Malhotra INDIA

Co Author(s):    D. Dhingra   A. Jain                 

Abstract Details


To report visualization of ‘pseudohyphae’ by In Vivo Confocal Microscopy (IVCM) in a case of presumed viral keratouveitis simulating fungal keratitis clinically


Cornea Services of Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India


A 39 year old female with history of trauma to the left eye by a wooden stick presented with severe dry looking keratitis with feathery margins, a mobile hypopyon and keratic precipitates. A differential diagnosis of Herpes Simples Virus (HSV) keratouveitis and fungal keratitis was considered. In view of an intact epithelium corneal scrapings were deferred and IVCM was performed to detect fungal hyphae. An aqueous tap was submitted for a pan fungal and viral polymerase chain reaction (PCR) analysis before initiating any specific treatment.


: IVCM revealed hyper reflective linear structures with branching in the anterior and mid stroma suggestive of fungal hyphae. Oral and topical antifungal agents were started to which the patient was unresponsive at the end of 48hours. The aqueous tap returned negative results for both fungal and viral DNA . Antifungal treatment was stopped and steroids (oral and topical) and oral acyclovir in therapeutic doses (400mg , 5times/day) were started, which led to significant improvement with disappearance of hypopyon within 2 days and complete resolution of the corneal infiltrates by 2 weeks.


Conclusion: IVCM , though a sensitive technique for detecting fungal hyphae in keratomycosis may sometimes be associated with false positive results. A reassessment of the diagnosis should be considered in cases which are unresponsive to treatment, even after the detection of ‘ hyphae like structures’ on IVCM.

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