Аннотация:Fungal keratitis is a time-sensitive ocular infection that often requires a high index of suspicion followed by intensive medical/surgical interventions to achieve a successful clinical outcome. The COVID-19 pandemic-related restrictions necessitated modification of conventional protocols and guidelines related to the plan of care of keratomycosis. We report four cases of atypical fungal keratitis presenting with poorly differentiated clinical characteristics. The challenges faced during their management were: 1) dilemma to clinically differentiate fungal (Scedosporium and Purpureocillium lilacinum) from bacterial keratitis; 2) treatment of Scedosporium and Trichosporon keratitis with natamycin monotherapy; 3) mixed infection of Candida albicans and Aureobasidium pullulans and continuing medications before rescraping the corneal ulcer against the recommended treatment guidelines; 4) phenotypic identification and differentiation among morphologically resembling fungi; and 5) decision making related to disparities between KOH and fungal culture results. Three patients responded well to conservative treatments. However, the fourth patient needed therapeutic keratoplasty, and was lost to follow-up due to travel related pandemic restrictions. This case series seeks to broaden the clinician's knowledge of rare but emerging moulds as presumptive aetiologies of keratomycosis. It also intends to reinforce the significance of early microbiological investigations, (direct microscopy and culture) in resource limited settings, for initiating empirical treatment towards a better visual prognosis.
