However, the epidemiology of keratomycosis is climate specific. In the Southern United States, Fusarium species are the most common cause of keratomicosis, with an especially high incidence in Florida. Organisms that infect pre-existent epithelial defects belong to the normal microflora of the conjunctiva and adnexa. Intrinsic virulence of fungi depends on the fungal substances produced and the host response generated. In contrast, Candida albicans produces phospholipase A and lysophospholipase on the surface of blastospores, facilitating the entrance to the tissue.
Corneal trauma is the most frequent and major risk factor for keratomycosis.
In fact, the physician should have a high level of suspicion if there is a patient with history of corneal trauma, particularly with plant or soil matter. Topical steroid use has definitively been implicated as a cause of increased incidence, development, and worsening of fungal keratitis. Other risk factors to consider are foreign body, corneal surgery, chronic keratitis, and immunosuppressive diseases. The clinical diagnosis of fungal keratitis is based on analysis of risk factors and the characteristic corneal features. In terms of corneal infiltration the classic and specific findings are feathery margins, elevated edges, rough texture, gray-brown pigmentation, satellite lesions, hypopyon and endothelial plaque.