The behavior of bacterial/fungal keratitis do not not allow the doctor to wait for laboratory support to start treatment as every moment is crucial in saving the cornea. After having sent the swabs for identification of infecting organism and culture/sensitivity reports, the best option seems in following "Imtiaz's law of inversely proportional hypopyon" which states that in fungal keratitis, hypopyon is less than the size of ulcer in contrast to bacterial ulcer where hypopyon is usually more in size than the ulcer area relatively. Therefore immediately embarking on treatment on the basis of this law seems justified.
Ref: Shah SIA et al: Concise Ophthalmology Text & Atals. 5th ed. Param B (Pvt.) Ltd. 2018: 48-49
I have treated bacterial/fungal keratitis based upon "Imtiaz's law of inversely proportional hypopyon" and found satisfactory results.
I do not think that such an statement is accurate and objective. I have treated many acute bacterial and fungal keratitis with varied hypopyon sizes, and was not able to make a positive correlation between hyopyon size with bacterial or fungal infection. I believe there are a number of uncontrolled variables, including the type of bacteria or fungi, the pathogenicity of the microorganism, the capacity of the immune response, the size of the inoculum or the reproductive capacity of the pathogen, among others, that preclude differentiate among microorganisms.
Dear Alejandro Rodriguez-Garcia, your statement seems purely scientific in absolute terms when classifying the infecting organism and going after culture and sensitivity information. However, if you happen to come across the situation in an endemic area, you will most probably agree with me as looking into the time factor, diagnostic facilities, state of health education amongst the patients and therapeutic response I have concluded that this law is most productive and accurate.
Dear Alejandro Rodriguez-Garcia, your recommendation clearly indicates that you are a transparent researcher with a deep sense of sympathy for humanity and not a researcher like robot who do not have a logical sense of elasticity in assessment and do not possess innate innovative capability. Hats off.