Dematiaceous fungal keratitis
C. Obtain aqueous fluid for fungal polymerase chain reaction
The appearance of the pigmented corneal lesions is suspicious for a melanin-producing fungal infection. Dematiaceous fungi contain darkly pigmented hyphae and are ubiquitous in vegetation around the world. They are common causes of pigmented keratitis in tropical climates but uncommon in temperate regions.1 Fungal infections should be considered in patients who are using long-term topical corticosteroids.2,3 Other risk factors include diabetes, systemic immunosuppression, corneal decompensation, ocular trauma with plant material, and ocular surgery.2,4 While fungal keratitis after cataract surgery, as in this case, has been described,5 the true incidence of postoperative fungal keratitis and endophthalmitis is not known.