Fungal keratitis – current diagnosis and therapeutic possibilities Review article

Main Article Content

Dominika Prokop
Ada Pandey
Małgorzata Gawlak
Bartosz Kuźlik
Kinga Czarnacka
Julia Kaczmarek
Ismael Alsoubie
Alicja Chmura-Hołyst
Aneta Pyza
Bartłomiej Żaczek
Anna Roszkowska
Ilona Pawlicka
Agnieszka Piskorz
Maciej Kozak


Keratitis and subsequent damage to the cornea resulting from infectious causes is one of the most serious problems facing ophthalmology today. One of the most common etiologies is fungal infection. Symptoms range from pain and visual deterioration, Wessely ring, inflammatory reaction in the anterior chamber or ropost. Diagnosis in addition to the classic medical and ophthalmologic examination consists of microscopic examination of scrapings, Gram examination combined with culture gives a 90% chance of detecting a fungal etiology. Good results are also observed with PCR testing, which helps speed up diagnosis. Treatment is time-consuming and has a high risk of complications. Two techniques are used to treat fungal infections of the cornea, surgical and pharmacological, such as the antifungal polyene antibiotics nystatin, natamycin, amphotericin B or thiazole derivatives like fluconazole and voriconazole. For filamentous fungi, natamycin 5% or voriconazole 1% are used at various intervals. Natamycin, despite the much poorer availability of the drug in countries such as Africa, has much better clinical results along with a lower risk of complications, as confirmed by the MUTT. A big problem also is subsequent bacterial superinfection, leading to the need for topical antibiotics. Surgical treatment is used in case of failure of pharmacotherapy, up to 4 weeks after the diagnosis of the disease, but it carries a high risk of complications. In the early stages of the disease, a new cross-linking technique can be considered, which is described as an alternative to direct antifungal or antibacterial treatment.


Download data is not yet available.

Article Details

How to Cite
Prokop D, Pandey A, Gawlak M, Kuźlik B, Czarnacka K, Kaczmarek J, Alsoubie I, Chmura-Hołyst A, Pyza A, Żaczek B, Roszkowska A, Pawlicka I, Piskorz A, Kozak M. Fungal keratitis – current diagnosis and therapeutic possibilities. Ophthatherapy [Internet]. 2023Dec.27 [cited 2024Jul.17];11(1):54-9. Available from:
Conservative treatment


1. Wylęgała E. Zapalenie rogówki. Medycyna Praktyczna. Online (access: 17.03.2023).
2. Rymgayłło-Jankowska B. Grzybicze zapalenie rogówki. Ophthatherapy. 2015; 2(6): 123-7.
3. Sharma N, Bagga B, Singhal D et al. Fungal keratitis: A review of clinical presentations, treatment strategies and outcomes. Ocul Surf. 2022; 24: 22-30.
4. Hill-Bator A, Bator K. Grzybicze schorzenia powierzchni oka. Ophthatherapy. 2018; suppl 1.
5. Nowik KE, Nowik K, Sulik-Tyszka B et al. Diagnostyka grzybiczego zapalenia rogówki. Aspekty kliniczne. Forum Zakażeń. 2020; 11(3): 131-4.
6. Austin A, Lietman T, Rose-Nussbaumer J. Update on the Management of Infectious Keratitis. Ophthalmology. 2017; 124(11): 1678-89.
7. Wasyluk J. Tomografia optyczna przedniego odcinka oka – nowe perspektywy. Ophthatherapy. 2019; 24(4): 287-93.
8. Prajna NV, Krishnan T, Rajaraman R et al.; Mycotic Ulcer Treatment Trial II Group. Effect of Oral Voriconazole on Fungal Keratitis in the Mycotic Ulcer Treatment Trial II (MUTT II): A Randomized Clinical Trial. JAMA Ophthalmol. 2016; 134(12): 1365-72.
9. Castano G, Elnahry AG, Mada PK. Fungal Keratitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
10. Arunga S, Kintoki GM, Gichuhi S et al. Delay along the care seeking journey of patients with microbial keratitis in Uganda. Ophthalmic Epidemiol. 2019; 26: 311-20.
11. Prajna NV, Mascarenhas J, Krishnan T et al. Comparison of natamycin and voriconazole for the treatment of fungal keratitis. Arch Ophthalmol. 2010; 128(6): 672-8.
12. FlorCruz NV, Evans JR. Medical interventions for fungal keratitis. Cochrane Database Syst Rev. 2015: CD004241.
13. Sharma S, Das S, Virdi A et al. Re-appraisal of topical 1% voriconazole and 5% natamycin in the treatment of fungal keratitis in a randomised trial. Br J Ophthalmol. 2015; 99: 1190-5.
14. Prost M, Jachowicz R, Nowak J. Kliniczna farmakologia okulistyczna. 1st ed. Elsevier Urban & Partner, Wrocław 2013: 149-55, 427-9.
15. Yilmaz S, Maden A. Severe fungal keratitis treated with subconjunctival fluconazole. Am J Ophthalmol. 2005; 140(3): 454-8.
16. Wylęgała E, Tarnawska D, Dobrowolski D (ed). Choroby rogówki. Górnicki Wydawnictwo Medyczne, Wrocław 2015: 87-8.
17. Anshu A, Parthasarathy A, Mehta JS et al. Outcomes of therapeutic deep lamellar keratoplasty and penetrating keratoplasty for advanced infectious keratitis: a comparative study. Ophthalmology. 2009; 116(4): 615-23.
18. Hafezi F, Hosny M, Shetty R et al.; PACK-CXL Working Group. PACK-CXL vs. antimicrobial therapy for bacterial, fungal, and mixed infectious keratitis: a prospective randomized phase 3 trial. Eye Vis (Lond). 2022; 9(1): 2.