Corneal Ulcer — Bacterial and Fungal MCQ — NEET PG Practice Question | NEETPGAI
Corneal Ulcer — Bacterial and Fungal
medium
eye Ophthalmology
A 52-year-old farmer from rural Maharashtra presents with a 10-day history of corneal ulcer with stromal infiltration and hypopyon. Gram stain shows branching filamentous organisms. Regarding fungal corneal ulcers, all of the following are true EXCEPT:
A. Fungal ulcers typically show rapid progression and perforation within 48 hours
B. Candida species are the most common cause of fungal keratitis in immunocompromised patients
C. Natamycin is the drug of choice for filamentous fungal keratitis
D. Fungal ulcers often present with a feathery margin and satellite lesions
Explanation
Fungal Corneal Ulcer — Key Characteristics
Key Point
Fungal corneal ulcers are notoriously slow-growing, indolent infections that progress over days to weeks, NOT hours. This is a critical distinguishing feature from bacterial ulcers.
Clinical Course & Progression
Table
Feature
Bacterial Ulcer
Fungal Ulcer
Onset
Acute (24–48 hrs)
Insidious (days to weeks)
Progression
Rapid, may perforate in 48–72 hrs
Slow, indolent; perforation rare unless neglected
Margin
Sharp, well-demarcated
Feathery, with satellite lesions
Stromal involvement
May be rapid
Deep stromal invasion common
Hypopyon
Common, may be large
Present but often less prominent
Management & Drug Choice
High-YieldNEET PG
Natamycin (pimaricin) 5% is the first-line topical antifungal for filamentous fungi (Aspergillus, Fusarium). Amphotericin B is reserved for Candida or when natamycin fails.
Clinical Pearl
Fungal ulcers are often misdiagnosed as bacterial initially because they respond poorly to antibiotics. The key clinical clue is the indolent course over 1–2 weeks with minimal discharge and a feathery, irregular margin.
Epidemiology & Risk Factors
Filamentous fungi (Aspergillus, Fusarium): agricultural trauma, plant material contact
Geographic variation: tropical and subtropical regions (India, Africa)
Warning
Topical corticosteroids accelerate fungal ulcer progression and are contraindicated until the infection is controlled.
Why Option 1 Is Incorrect
Fungal corneal ulcers progress slowly over days to weeks, not rapidly with perforation in 48 hours. Rapid perforation is characteristic of aggressive bacterial ulcers (especially Pseudomonas). This slow progression is why fungal ulcers are often missed on initial presentation.
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