Mycology
Septate Filamentous Fungi
A significant majority of external ocular
mold infections are caused by septate
fungi. Among the genera that have been
isolated from the external eye are
Aspergillus, Alternaria, Curvularia,
Paecilomyces, Scedosporium, and
Phialophora.
Septate hyphae of filamentous fungus (Fusarium solani).
(Diff-Quick stain
Nonseptate Filamentous Fungi
Nonseptate filamentous fungi include the
Mucor, Rhizopus, and Absidia species in
class Zygomycetes, order Mucorales,
family Mucoraceae. P jiroveci is an
important cause of choroiditis in
HIVinfected individuals, the incidence of
which is declining in the era of
antiretroviral therapy.
Yeasts (Candida albicans). (Gram ×1000.) (Courtesy of
James Chodosh, MD.)
 Parasitology
1. Protozoa 2. Helmints
• The Acanthamoeba life cycle includes • Onchocerciasis is caused by
a motile trophozoite form (15–45 μm onchocercal filariae transmitted
in diameter) and a dormant cyst form by the bite of the blackfly
(10–25 μm in diameter)
(Simulium), which lays its eggs on
vegetation in fast-flowing rivers
(hence the common name river
blindness) and is endemic in parts
of sub-Saharan Africa, the Middle
East, and Latin America.

Acanthamoeba cyst. (Diff-Quick stain ×100.) (Courtesy of Elmer Y. Tu,

MD.)
 3. Antrhopoda

Phthirus pubis : Phthiriasis is a venereally acquired crab

louse (Phthirus pubis) infestation of coarse hair in the pubic,
axillary, chest, and facial regions. Adult female crab lice and
immature nits on the eyelashes cause
blepharoconjunctivitis.

Figure Crab louse (Phthirus pubis). (Wet

mount ×200.)

Demodex species : Demodex folliculorum and

Demodex brevis inhabit normal superficial hair and eyelash
follicles and deeper sebaceous and meibomian glands,
respectively, with an increased incidence in facial glands
being associated with rosacea

Fly larvae : Myiasis occurs when maggots invade and Figure Demodex. (Wet mount ×100.)
(Courtesy of Elmer Y. Tu, MD.)
feed on the living or dead tissues of humans or animals.
Ophthalmomyiasis (maggot infestation of the eye) can refer
to external or internal infestation and involve almost any
ocular tissue.
 Fungal and Parasitic Infections of the
Eyelid Margin
The role of these parasites in the pathogenesis of blepharitis is unclear, but some patients may
experience an inflammatory response with infestation. The infestation may respond to dilute tea
tree oil applied to the base of the eyelashes. Other organisms that survive on lipids of eyelid
glands, such as Malassezia furfur, have also been incriminated in certain types of blepharitis.

Demodex-associated sleeves. (Courtesy of Elmer Y. Tu, MD.)

A focal granuloma or dermatitis affecting the eyelid or conjunctiva can be caused by very rare
infections, including :

• blastomycosis
• sporotrichosis
• rhinosporidiosis
• cryptococcosis
• leishmaniasis
• Ophthalmomyiasis

Mechanical removal of the lice and nits

(eggs) can be performed with jewelers
forceps, but pubic hairs are usually treated OPTHALMOMIIASIS EKSTERNA YANG DISEBABKAN OLEH DERMATOBIA HOMINIS

with a pediculicide. Any ointment can

smother the lice and should be applied
twice daily for at least 10 days, because the
incubation period (of the nits) is 7–10 days.
Periodic reexamination is recommended
over 10–14 days to detect recurrence and
remove any new nits. Bed linen, clothing,
and any items of close contact should be
washed and dried at the highest
temperature setting (at least 50°C).