Managing a Pigmented Corneal Ulcer in a 58-Year-Old Patient

Abstract

We report on a case study involving a 58-year-old male with a pigmented corneal ulcer. The patient presented with a two-month history of an unresolved corneal ulcer in the oculus sinister (OS), accompanied by increasing ocular discomfort. His best corrected visual acuity (BCVA) was 20/20 oculus dexter and hand motion OS. Examination of OS revealed mild conjunctival injection, diffuse corneal edema, and the presence of a central pigmented lesion. Microbiological analysis via culture identified the causative agent as Ochroconis fungi, belonging to the dematiaceous species. Subsequently, the patient's condition was managed through a comprehensive regimen that included multiple topical antifungal agents, a topical antibiotic, and povidone-iodine drops. After two months of treatment, the patient exhibited improvement in his condition. His BCVA improved to counting fingers at a distance of two feet OS.

Keywords: corneal disease; dematiaceous fungi; fungal keratitis; ophthalmology; pigmented corneal ulcer.

Figure 1. External examination and slit-lamp view of the left eye.

External examination (A) and slit-lamp view (B) of the left eye with fluorescein-highlighted diffuse conjunctival injection and central pigmented keratitis.