Aspergillus keratitis with intraocular invasion.

A healthy 48-year-old man developed Aspergillus keratitis following mild corneal trauma. Intensive medical therapy, initially empirical, then guided by in vitro sensitivity testing, as well as attempts at surgical excision of the infection, were ultimately unsuccessful. The poor therapeutic response may have been due to fungal penetration of the deep corneal stromal before treatment was initiated. The clinical and histologic features of A keratitis are described and related to fungal keratitis in general. The strengths and limitations of laboratory diagnostic aids are discussed. Fungal keratitis may follow a disarmingly mild early clinical course, but requires prompt, aggressive therapy if serious complications are to be avoided.