For a superficial infiltrate (in the anterior 2/3 of the stroma and smaller than 1.5 mm)
Start amphotericin B 0.15% and chlorhexidine 0.02%
For a deep infiltrate (deeper than 2/3 of the stroma and/or larger than 1.5 mm) and/or tissue loss
Refer to a tertiary centre
Start chlorhexidine 0.2%, amphotericin B 0.15% and voriconazole 1%
For adequate penetration of the medication it is necessary that the epithelium is debrided daily for at least the first three days.
Dosage, for all agents: first 48 hours every hour (24/7), thereafter every hour during the day for 5 days. Then at least every 2 hours for 3 weeks or until the infiltrate has become a scar and the inflammatory reaction has resolved.
Do not give steroids.
Adjust therapy according to culture results. Consult with a medical microbiologist.
In case of treatment failure consider:
Intracameral injection with voriconazole 100 μg/0.1 mL or amphotericin B deoxycholate 25 μg/0.1 mL
For a superficial infiltrate (in the anterior 2/3 of the stroma and smaller than 1.5 mm)
For a deep infiltrate (deeper than 2/3 of the stroma and/or larger than 1.5 mm) and/or tissue loss
Start chlorhexidine 0.2%, amphotericin B 0.15% and voriconazole 1%
For adequate penetration of the medication it is necessary that the epithelium is debrided daily for at least the first three days.
Dosage, for all agents: first 48 hours every hour (24/7), thereafter every hour during the day for 5 days. Then at least every 2 hours for 3 weeks or until the infiltrate has become a scar and the inflammatory reaction has resolved.
Do not give steroids.
Adjust therapy according to culture results. Consult with a medical microbiologist.
In case of treatment failure consider:
Intracameral injection with voriconazole 100 μg/0.1 mL or amphotericin B deoxycholate 25 μg/0.1 mL
Natamycin 5% eye drops (NB: not registered in the Netherlands. If desired, possible to import from the USA. Note: import licence and medical statement required, delivery takes 21 days and costs €400 per bottle)