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8 Cards in this Set
- Front
- Back
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Antifungals
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-No topical antifungal available
-Difficult to produce -Ocular antifungal infections are rare -Occur most after surgery or depressed immune system -Fungal spores in farming areas can cause (doesn’t have to be from abrasion) -Causes severe ocular damage -Prompt and effective treatment to avoid loss of eye -Fungal toxins cause damage after fungus eliminated -Tablets and ointments (external) |
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Polyenes
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-Antifungal agent
-Alter fungal cell membrane permeability, bind to sterol moiety of membrane -Poor penetration, intravitreal for endophthalmitis -Highly toxic⇒ retinal damage, renal toxicity, reversible anaemia, fevers, chills, hypotension -Amphotericin B, Nystatin |
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Pyrimidines
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-Antifungal agent
-Flucytosine |
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Imidazoles Azoles and Triazole Azoles
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-Antifungal agent
-Alter fungal cell membrane permeability -Miconazole, ketoconazole (IAs) -Itraconazole, fluconazole (TAs) |
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Fungal Infections
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-Uncommon ocular pathogens
-May be hard to distinguish from bacterial infections (won’t respond to antibiotics) -Occurs in already compromised eye (ocular surface disease, long term steroid use) -Slow, relentless infection |
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Antifungal use for:
FUNGAL KERATITIS |
-Antibiotics inactive
-Ulcer with posterior corneal involvement -pearls on back of cornea -Refer to corneal specialist -Send corneal scrape to lab -Treat with antifungal agents when diagnosed (drugs are toxic to cornea) -Topical and oral antifungal agents -Amphotericin B, Ketoconzole, fluconazole, itraconozole, flucytosine -Frequent administration for prolonged period (12 weeks at least) -Topical corticosteroids are contraindicated |
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Antifungal use for:
ENDOPHTHALMITIS |
-Ocular emergency, urgent referral
-Bacteria cause, unusual for fungi -Entry to eye via wound (surgery, penetrating injury) -Reduce post-operative risk by treating infections before surgery -instil povidine iodine immediately post surgery (reduce risk) -Intravitreal injection of antibiotics (vancomycin, ceftazidine) and steroid (dexamethasone) -Topical, oral and IV antibiotics are ineffective on their own |
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Antifungal use for:
ACANTHAMOEBA KERATITIS |
-Ubiquitous protozoan that rarely infects cornea
-Cease contact lens wear immediately (reintroduce after 6mths) -Lab identification (scraping) -Commence treatment using anti-amoebic drugs after confirmation (propamidine, neomycin and 0.02% polyhexamethylene-biguanide (PHMB) or topical chlorhexidine) -Refer, reviewed weekly until clinical improvement seen |
