Smear First! OPD Microscopy as a Diagnostic Compass in Corneal Ulcers

Purpose: To analyze the microbiological profile of corneal scrapings from patients with infectious keratitis presenting to a tertiary eye care hospital in Western Uttar Pradesh, India. Methods: This retrospective study included patients with clinically diagnosed infectious keratitis who underwent corneal scraping between July 2022 and April 2025. Samples were collected under aseptic conditions and examined using Gram stain and 10% Potassium Hydroxide (KOH) wet mount. Results: Among 221 patients, 121 (54.75%) showed fungal elements on KOH, and 32 (14.47%) demonstrated bacteria on Gram stain (29 Gram-positive cocci, 3 Gram-negative rods). The remaining 64 samples were either negative or inconclusive. Males constituted 69.2% of the study population, with peak incidence in the 40-60 years age group. Conclusion: Fungal pathogens were the predominant cause of infectious keratitis in this cohort. Smear-based microscopy remains a rapid, accessible, and clinically valuable diagnostic tool, especially in resource-limited settings.