Abstract: Fungal keratitis is a serious ocular infection caused by fungal pathogens, often resulting in corneal inflammation and tissue damage. This article provides an insightful exploration of fungal keratitis, elucidating its diverse etiology, clinical manifestations, diagnostic modalities, treatment strategies, and prognostic considerations.

Introduction: Fungal keratitis poses a significant clinical challenge, particularly in regions with high agricultural activity or tropical climates. Understanding the risk factors, clinical features, and appropriate management approaches is crucial for achieving optimal outcomes in affected individuals.

Etiology and Risk Factors: Fungal keratitis can arise from various fungal species, including Fusarium, Aspergillus, Candida, and others. Predisposing factors commonly associated with fungal keratitis include ocular trauma, contact lens wear, agricultural or outdoor activities, and pre-existing ocular surface diseases. Environmental factors such as humidity, temperature, and soil contamination may also influence disease prevalence. (Source: American Academy of Ophthalmology – Fungal Keratitis)

Clinical Presentation: Fungal keratitis typically presents with symptoms such as ocular pain, redness, photophobia, and blurred vision. Corneal findings may include epithelial defects, stromal infiltrates, feathery margins, and satellite lesions. In severe cases, corneal perforation or endophthalmitis may occur, leading to vision-threatening complications.

Diagnosis: Diagnosing fungal keratitis requires a high index of suspicion and a combination of clinical examination, microbiological testing, and imaging studies. Corneal scrapings for microscopy, culture, and molecular techniques are essential for identifying the causative organism. In vivo confocal microscopy and anterior segment optical coherence tomography (OCT) may aid in assessing corneal involvement and monitoring treatment response.

Treatment Strategies: Management of fungal keratitis involves both medical and surgical interventions aimed at eradicating the fungal infection, preserving corneal integrity, and optimizing visual outcomes. Topical antifungal agents, such as natamycin, voriconazole, or amphotericin B, are the mainstay of medical therapy. In refractory cases or those with impending perforation, therapeutic keratoplasty or emergent surgical intervention may be necessary.

Prognosis: The prognosis of fungal keratitis varies depending on various factors, including the causative organism, disease severity, promptness of diagnosis, and appropriateness of treatment. Despite aggressive therapy, some cases may result in corneal scarring, visual impairment, or the need for corneal transplantation. Early recognition and management are critical for minimizing complications and preserving vision.

Conclusion: In conclusion, fungal keratitis represents a challenging ocular infection associated with significant morbidity and potential vision loss. Timely diagnosis, appropriate antifungal therapy, and close monitoring are essential for optimizing outcomes and preventing sight-threatening complications. By raising awareness, implementing preventive measures, and fostering collaboration among healthcare providers, we can effectively combat the burden of fungal keratitis and improve ocular health outcomes.