Aspergillus Infections of the Ear, Eye and Nails

Medical illustration showing an ear, eye and fingernails, representing local Aspergillus infections. — Local Aspergillus infections of the ear, eye or nails are usually separate from lung aspergillosis.

Aspergillus can occasionally cause local infections of the ear, eye or nails. These are different from lung aspergillosis and usually do not mean that an existing lung condition is spreading through the body.

They can still need the right specialist assessment. The key is to recognise when symptoms need prompt attention, especially if the eye is involved.

Key points

Ear, eye and nail infections are usually local conditions.
They are not usually caused by CPA, ABPA or another chronic lung form of aspergillosis spreading through the body.
Many other conditions can cause similar symptoms, so a correct diagnosis matters.
Eye symptoms need urgent assessment because infections of the eye can threaten sight.
Ear and nail infections are often treatable but may need a sample or specialist review.

How common are these conditions?

Ear, eye and nail symptoms are far more often caused by something other than Aspergillus.

Ear symptoms are commonly due to earwax, eczema, irritation or bacterial outer-ear infection. Fungal ear infection is less common, and Aspergillus is only one possible cause.
Red, painful or irritated eyes are much more often caused by dryness, allergy, viral or bacterial infection, or another eye condition. Fungal eye infection is uncommon, but it needs urgent assessment because it can be serious.
Nail changes are commonly caused by injury, skin conditions or other fungi. Even when a nail infection is fungal, Aspergillus is not the usual cause.

So these conditions are worth recognising, but they are not something most people with aspergillosis should expect to develop. A clinician may need to examine the area or take a sample before confirming the cause.

Aspergillus infection of the ear

A fungal infection of the outer ear canal is called otomycosis. Several fungi can cause it, including Aspergillus and Candida. It is a local infection of the ear canal, not a lung infection.

Possible symptoms include:

Itching or irritation in the ear
Earache or discomfort
A blocked feeling or reduced hearing
Discharge or debris from the ear
Flaking skin around the ear canal

Otomycosis can be more likely after repeated water exposure, local irritation, ear eczema, use of cotton buds or previous ear treatment. It can also occur in people with diabetes or reduced immune defences.

A GP, pharmacist or ENT clinician may examine the ear. Treatment commonly involves careful removal of debris and local treatment chosen for the likely cause. Avoid putting cotton buds, hairpins or unprescribed drops into the ear canal, as this can worsen irritation or push material deeper inside.

Aspergillus infection of the eye

Fungal infection of the eye is uncommon, but it is important because it can damage sight if treatment is delayed. Infection of the cornea, the clear surface at the front of the eye, is called fungal keratitis.

Aspergillus is one possible cause. Infection may be more likely after an eye injury, particularly one involving soil, plant material or dust, after eye surgery, or in people with certain eye conditions or major immune suppression.

Seek urgent eye-care advice if you have:

A painful red eye
New sensitivity to light
Blurred or reduced vision
A white or cloudy spot on the surface of the eye
Eye pain or redness after an injury

Do not try to self-treat a painful or red eye with leftover drops. An optometrist, eye casualty service or ophthalmology team can assess the cause and arrange specialist treatment if needed.

Aspergillus infection of the nails

Aspergillus can occasionally cause a fungal nail infection. However, many nail changes are caused by other fungi, psoriasis, eczema, injury, circulation problems or ordinary ageing.

Nails may become thicker, discoloured, brittle, crumbly or partly detached from the nail bed. These changes do not show which organism is responsible.

A clinician may take a clipping or scraping before recommending treatment. This helps avoid unnecessary medicines and allows treatment to be matched to the likely cause. Nail infections often take time to improve because healthy nail has to grow back.

Does this mean my lung aspergillosis is spreading?

Usually, no. A local ear, eye or nail infection is not normally evidence that CPA, ABPA, Aspergillus bronchitis or an aspergilloma is spreading through the body.

Tell your treating team about any new diagnosis, particularly if you are taking antifungal medicines or immune-suppressing treatment, so they can consider possible interactions and your wider health. But a new local problem is usually assessed through the relevant GP, ENT, eye or dermatology service.

When should I seek advice?

Arrange a routine appointment for persistent ear symptoms, changing nails or recurrent local infections. Seek urgent eye-care advice for eye pain, redness, light sensitivity or any change in vision.

If you are severely immunocompromised, have recently had an organ or stem-cell transplant, or are receiving intensive cancer treatment, contact your specialist team promptly about new or worsening symptoms.