review · Journal of Fungi
Fungal keratitis is a prominent treatable cause of blindness, particularly affecting young people, with an estimated one million to nearly 1.5 million eyes impacted every year. Between 8 and 11 per cent of affected patients eventually require surgical removal of the eye. Diagnosis depends on direct microscopy, corneal scraping, and fungal culture to identify a wide range of airborne fungi. Effective management requires intensive application of antifungal eye drops, ideally natamycin, and frequently involves surgical intervention. However, modern guidelines for diagnosis and care remain absent. In low-resource settings, patient outcomes are severely compromised by diagnostic delays, lack of testing, ineffective antibacterial treatments, and the inappropriate use of corticosteroid eye drops, frequently leading to unilateral or bilateral blindness. Designating fungal keratitis as a neglected tropical disease could significantly improve global awareness, enhance diagnostic capacity, and expand access to affordable antifungal medications.
Over a million people risk losing their sight or their eyes each year to fungal keratitis, despite the condition being treatable. In resource-limited regions, poor diagnostic tools and inappropriate therapies exacerbate vision loss. Formally recognising the infection as a neglected tropical disease provides a clear route to establishing standardised treatment guidelines, expanding access to essential antifungal drugs, and preventing avoidable blindness among young populations.
The abstract identifies an urgent global need for accessible diagnostic capabilities and affordable antifungal therapies, particularly natamycin eye drops. While primarily an advocacy argument for policy recognition rather than a technical product evaluation, this work highlights clear application areas for diagnostic manufacturers and pharmaceutical developers to supply low-cost, point-of-care ocular diagnostics and specialised antifungal formulations to underserved, low-resource healthcare markets.
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Amongst the treatable cause of blindness among young people, fungal keratitis ranks high. There are an estimated 1,051,787 to 1,480,916 eyes affected annually, with 8-11% of patients having to have the eye removed. Diagnosis requires a corneal scraping, direct microscopy and fungal culture with a large number of airborne fungi implicated. Treatment involves the intensive application of antifungal eye drops, preferably natamycin, often combined with surgery. In low-resource settings, inappropriate corticosteroid eye drops, ineffective antibacterial therapy, diagnostic delay or no diagnosis all contribute to poor ocular outcomes with blindness (unilateral or bilateral) common. Modern detailed guidelines on fungal keratitis diagnosis and management are lacking. Here, we argue that fungal keratitis should be included as a neglected tropical disease, which would facilitate greater awareness of the condition, improved diagnostic capability, and access to affordable antifungal eye medicine.
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DOI: 10.3390/jof8101047
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