Mustafa Tawfeeq Halboos Al Rubaye

Abstract :

Infectious keratitis (IK) is a vision-threatening ocular disease and one of the leading causes of corneal blindness worldwide. It is caused by a wide range of pathogens, including bacteria, fungi, viruses, and protozoa, with disease prevalence varying according to geographic location, climate, and patient-related risk factors. Common predisposing factors include contact lens wear, ocular trauma, ocular surface disorders, previous ocular surgery, diabetes mellitus, and immunosuppression. Delayed diagnosis or inappropriate treatment may result in severe complications, including corneal scarring, perforation, and permanent vision loss. Accurate identification of the causative pathogen is therefore essential for timely and targeted therapy. Conventional diagnostic methods, including slit-lamp examination, corneal scraping, Gram staining, potassium hydroxide (KOH) preparation, and microbial culture, remain the foundation of clinical diagnosis. However, recent advances in molecular diagnostics, such as polymerase chain reaction (PCR), real-time PCR (RT-qPCR), next-generation sequencing (NGS), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), have significantly improved diagnostic sensitivity, specificity, and turnaround time. In addition, artificial intelligence (AI)-based imaging systems have shown promising potential for rapid and accurate clinical diagnosis. The increasing emergence of antimicrobial-resistant pathogens has created significant therapeutic challenges, highlighting the need for innovative treatment strategies. Recent developments, including novel antibiotics, antimicrobial peptides, photoactivated chromophore for infectious keratitis–corneal collagen cross-linking (PACK-CXL), bacteriophage therapy, nanoparticle-based drug delivery systems, stem-cell therapy, and immunotherapy, offer promising alternatives to conventional treatment. This review summarizes the current epidemiology, risk factors, pathogenesis, clinical manifestations, diagnostic advances, and emerging therapeutic strategies for infectious keratitis. Furthermore, it highlights future perspectives aimed at improving early diagnosis, optimizing targeted therapy, and reducing the global burden of corneal blindness associated with this sight-threatening disease.