Corneal Ulcer: Differences Between Bacterial And Fungal Types

Bacterial Ulcer	Fungal Ulcer
1.History of trauma to the cornea, contact lens wear	1.History of trauma with vegetable matter
2.Pain, redness, watering, decrease in vision. Lid oedema (marked in gonococcal ulcer), purulent discharge in gonococcal ulcer and bluish green discharge in pseudomonas corneal ulcer	2.Pain and redness are similar to bacterial ulcer. But lid oedema is minimal even in severe cases unless patients have received native medicines or peri ocular injections.
3.Round or oval in shape involving central or para central part of the cornea. Rest of the cornea is clear. Hypopyon may or may not be present. In pneumococcal ulcer the advancing border will have active infiltrate with undermined edges and the trailing edge may show signs of healing. Most of the pneumococcal ulcers will show leveled hypopyon associated with Dacryocystitis. Pseudomonas ulcer will have short duration, marked stromal oedema adjacent to the ulcer with rapid progression. If untreated, will perforate within 2-3 days. Advanced ulcer may involve the sclera also. Ulcers caused by Moraxella and Nocardia are slowly progressive in immunocompromised hosts.	3.Early fungal ulcer may appear like a dendritic ulcer of herpes simplex virus. The feathery borders are pathognomonic clinical features. Satellite lesions, immune ring, and unlevelled hypopyon may also be present. The surface is raised with greyish white creamy infiltrates, which may or may not appear dry. Ulcer due to pigmented fungi will appear as brown or dark; raised, dry, rough, leathery plaque on the surface of the cornea