Fungal keratitis: a persistent challenge in modern ophthalmology

INTRODUCTION Fungal keratitis represents a significant cause of visual morbidity worldwide, with incidence varying substantially by geographic region and socioeconomic factors. Early diagnosis and effective treatment remain major clinical challenges.AREAS COVERED This review synthesizes current knowledge on fungal keratitis through comprehensive literature analysis covering epidemiology, pathophysiology, diagnostic approaches, and therapeutic strategies. The most frequently isolated pathogens include Candida, Fusarium, and Aspergillus species, with predominant organisms differing between tropical and temperate climates. Diagnostic methods are examined, including conventional culture direct microscopy, confocal microscopy, and emerging technologies such as molecular methods and artificial intelligence. Current therapeutic approaches including topical antifungals, systemic therapy, intrastromal and intracameral injections, and surgical intervention are discussed.EXPERT OPINION Despite advances in diagnostics and therapeutics, outcomes remain guarded due to diagnostic delays, limited antifungal efficacy against filamentous fungi, and extensive subclinical organism spread. Future progress depends on accessible molecular diagnostics, AI integration, novel antifungal development, and earlier surgical intervention. Gene sequencing combined with artificial intelligence shows particular promise for rapid diagnosis and cost reduction.