Purpose: To report a patient with vernal keratoconjunctivitis who developed
mycotic keratitis in absence of known risk factors.
Methods: A 17-year-old male suffering from vernal keratoconjunctivitis pres
ented with infective keratitis. The patient had been treated in the past wi
th topical antihistaminics and vasoconstrictors. The patient had not been e
xposed to topical steroids in 2 years of follow-up. He did not have dry eye
or corneal micro or macroerosions prior to the development of infective ke
ratitis. Corneal scrapings were obtained and subjected to KOH wet mount sme
ar, calcofluor and Grams stain as well as bacterial culture sensitivity and
fungal culture.
Results: Clinical diagnosis of mycotic keratitis in association with vernal
conjunctivitis was supported by microbiological investigations. KOH wet mo
unt and calcofluor staining showed presence of filamentous septate hyphae w
hile fungal culture showed growth of aspergillus fumigatus. Antifungal ther
apy was initiated in the form of topical natamycin 5% suspension to which t
he patient responded and recovered 6/6 final visual acuity.
Conclusion: The authors wish to conclude that patients suffering from verna
l keratoconjunctivitis, even in the absence of corneal involvement, steroid
exposure and trauma, may be at increased risk of developing keratomycosis.