bilateral candida keratitis in a patient with transconjunctival substance abuse

purpose : to report an unusual case of bilateral candida keratitis in a young drug abuser case report : a 19-year-old man sought medical care for his left eye redness, pain and photophobia. on slit-lamp examination a well-defined paracentral exudative corneal ulcer was observed. smear from the corneal ulcers contained pseudohyphae and accordingly a routine regime of antifungal therapy (topical drop of amphotericin-b 0.15% q1h beside out-patient daily follow-up) was commenced. although the signs and symptoms improved initially, the corneal ulcer grew even larger in the third day of treatment and the contralateral cornea also began to show preliminary signs of fungal infection. further work-ups revealed that his bilateral candida keratitis had happened in association with an unusual route of drug abuse (transconjunctival heroin abuse). clinical response was achieved by additional topical voriconazol (1% q1h) and systemic fluconazol (200 mg bid). conclusion : candida keratitis in the context of previous drug abuse and the presence of bilateral keratoconjunctivitis beside kissing conjunctival lesions may serve as diagnostic clues for this very rare condition.   iranian journal of ophthalmology 201224(1):71-74 © 2012 by the iranian society of ophthalmology