How do I distinguish between new-onset fungal eye infection vs. bacterial conjunctivitis in contact-lens wearers?
—Felix N. Chien, DO, Newport Beach, Calif.

Fungal disease presents as a corneal ulcer with white or creamy infiltrates. Stellate or feathery edges may be seen on slit-lamp examination. The pain and visual loss of fungal ulcers are not characteristic of bacterial conjunctivitis or “pinkeye.” Prompt referral with appropriate cultures and treatment by an ophthalmologist are essential since a delayed diagnosis of fungal ulcer may result in visually disabling corneal scarring or even corneal perforation. As with any eye condition in which a fungus or herpes simplex infection might be involved, corticosteroid eyedrops are contraindicated.
—B. David Gorman, MD (120-11)