FUNGAL KERATITIS - AN UPDATE ON THE GLOBAL THREAT

Fungal keratitis (FK) is a sight-threatening disease caused by infection of the cornea by filamentous fungi or yeasts. FK can be challenging to diagnose and treat. In tropical, low, and middle-income countries, it accounts for the majority of cases of microbial keratitis (MK). Filamentous fungi, in particular, Fusarium spp., the aspergilli, and dematiaceous fungi are responsible for the most significant burden of disease. The predominant risk factor for filamentous fungal keratitis is trauma, typically with organic, plant-based material. In 2020, the incidence of FK was estimated to be over 1 million cases per year, with a significant geographical variation. Diagnosing FK is challenging accurate diagnosis relies on reliable microscopy and culture. Current topical antifungals are not very effective infections can progress despite prompt treatment. Antifungal drops are often unavailable. When available, natamycin is usually the first-line treatment. However, infections may progress to perforation in ~25% of cases. Future work needs to be directed at addressing these challenges and unmet needs. This review discusses the epidemiology, clinical features, diagnosis, management, and etiology of FK.