A 48 year old diabetic with orbital cellulitis presented with a corneal ulcer. An aqueous tap showed branched hyphae. Diagnosis is –
**Core Concept**
The underlying principle being tested is the diagnosis of fungal corneal ulcers, particularly in immunocompromised patients such as diabetics. **Fungal keratitis** is a serious infection of the cornea that can lead to vision loss if not treated promptly. The presence of **branched hyphae** in the aqueous tap is a key diagnostic feature.
**Why the Correct Answer is Right**
The correct answer is related to the diagnosis of **fungal keratitis**, specifically **Aspergillus** or **Fusarium** species, which are common causes of fungal corneal ulcers. The presence of **branched hyphae** in the aqueous tap is characteristic of these infections. The patient's diabetic status and presentation with orbital cellulitis and a corneal ulcer are also consistent with this diagnosis.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not match the description of the correct answer.
**Option B:** This option is incorrect because it is not related to the diagnosis of fungal keratitis.
**Option C:** This option is incorrect because it is not a common cause of fungal corneal ulcers.
**Option D:** This option is incorrect because it is not the correct diagnosis based on the presence of branched hyphae.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that **fungal keratitis** is a medical emergency that requires prompt treatment with antifungal medications. Delayed treatment can lead to vision loss and other complications.
**Correct Answer:** D. Fungal keratitis.