The aim of the study was to report the clinical and microbiological profiles of Fusarium keratitis. In this single-centre, retrospective, non-comparative case series, 47 laboratory-confirmed cases of keratitis caused by Fusarium species treated at the L V Prasad Eye Institute, Bhubaneswar, India, between November 2006 and October 2009, were reviewed. The analysis included predisposing factors, clinical characteristics, microbiological findings, treatment and outcome. Forty-seven samples of 47 patients were included in the study. The mean age of the 47 patients was 46 ± 17 years. Twelve eyes had a history of injury. Corneal scraping could not be done in one of the cases due to large perforation. Fungal filaments were detected in corneal scraping in 41 cases, and in three cases microconidia were observed in microscopy. Fusarium solani was the most common species (44.7 %). All three cases where microconidia were present in smear were identified as F. solani in culture. The mean time to positive culture was 2.4 ± 1.5 days. Twenty-three patients underwent adjunctive surgical procedure. Visual acuity of <20/200 at presentation and final follow-up was noted in 80.9 and 51.4 % patients, respectively. One-half (23/47) of the patients had improvement in visual acuity. Fusarium keratitis may present after trauma without any satellite lesion, and the response to medical therapy is generally poor. Rapid diagnosis can be made by smear examination of corneal scrapings in a majority of the cases and confirmed by culture within 2-3 days. Presence of microconidia in smear examination may be suggestive of F. solani.

Acantholytic acanthoma is a benign epidermal tumor with a truncal predisposition and is not previously reported as an eyelid mass. A 63-year-old man, presented with a history of nodular masses of both his eyelid margin and eyelid surface of 3 years duration. Excision biopsy of lesion of eyelid margin was consistent with dermal nevus. Lesions of the eyelid surface displayed prominent acanthosis, acantholysis, and spongiosis. Variable hyperkeratosis and papillomatosis was also noted. There was absence of cytological atypia or mitoses. The microscopic picture was consistent with acantholytic acanthoma. The presence of extensive acantholysis in the present case excluded incidental focal epidermolytic hyperkeratosis and focal acantholytic dyskeratosis. Acantholytic vesiculobullous disorders and numerous acanthotic disorders, which are more common in the eyelid, need exclusion. To the authors' best knowledge, as acantholytic acanthoma of the eyelid is not previously reported, they recommend that it should be included as differential diagnoses of benign epidermal lesions of eyelid.

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