<prompt> Which of the following is not a feature of fungal corneal ulcer?Fixed hypopyonUlcer with sloughing marginsSymptoms are more pronounced than signsFungal hyphae are seen on KOH mount  <response>: Ans. c. Symptoms are more pronounced than signs Ref: Khurana 5e p101; 4e p100; Parson 21ste p199-200 ; Kanski 7e p180-82Symptoms are much milder than the clinical signs in fungal corneal ulcer hut not the vice-versa.Fungal Mycotic Corneal Ulcer:Symptoms are much milder than the clinical signsQ.Ulcer is dry looking, grayish white with elevated rolled out marginsQ and feathery finger like extensions into surrounding stromaQ under intact epithelium.A big hypopyonQ is present even if the ulcer is very small.Unlike bacterial ulcer, the hypopyon may not be sterile pseudohypopyonQ as fungi can penetrate into anterior chamber without perforation.Diagnosis: Examination of wet KOH mountQ, calcoflour white for fungal hyphae and culture on sabourauds medium.Fungal Mycotic Corneal Ulcer KeratomycosisAspergillus fumigates MC, Candida and fusariumQ are common agents.Injury by vegetative materials or animal tailQ is common modes of infection.Etiology:Filamentous septate hyphae tubular projections producing multicellular fungi, most notably, Fusarium and Aspergillus fumigatus are the most common causative organism in tropics or hot climate and around the wordUnicellular budding yeast e.g. Candida is most common cause of fungal keratitis in temperate cold regions.Predisposing Factors Injury by vegetative materials or animal tail is common modes of infectionQ. Excessive use of antibiotics Corneal trauma involving plant matter or gardening agricultural tool in tropics Comeal disease Local immunosuppression Long term use of topical steroid Prior comeal transplantation Contact lens wear Diabetes mellitusClinical Features:Symptoms are much milder than the clinical signsQMarked ciliary and conjunctival congestion but symptoms of pain, watering and photophobia are disproportionately less.Ulcer is dry looking, grayish white with elevated rolled out marginsQ and feathery finger like extensions into surrounding stromaQ under intact epithelium.A sterile immune ring yellow line of WesseleyQ present where fungal antigen and host antibody meet.Multiple small satellite lesionsQ may be present around the ulcer.A big hypopyonQ is present even if the ulcer is very small.Unlike bacterial ulcer, the hypopyon may not be sterile pseudohypopyonQ as fungi can penetrate into anterior chamber without perforation.Perforation is rare and corneal vascularization is conspicuously absentQ.Diagnosis:Examination of wet KOH mountQ, calcoflour white for fungal hyphae and culture on sabourauds medium.TreatmentAntifungal TreatmentAdjuvant Therapy Natamycin and amphotericin B are used in filamentous infectionsQ topically. Imidazole and flucytosine are used in Candida infection. Systemic antifungal is required for severe keratitis and endopthalmitis. CycloplegicsQ as atropine or scopolamine are used to reduce ciliary spasm, uveal inflammation and prevent posterior synechiae formation. Anti-inflammatory and analgesics Carbonic anhydrase inhibitors for complications as secondary glaucomaQ 