Emerging Ocular Pathogen Resistance and Clinically Used Solutions: A Problem That Is More than Meets the Eye.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Antimicrobial resistance (AMR) in ocular infections poses a significant threat to vision preservation.
• Multidrug resistance rates in ophthalmology are high, mirroring global trends and rendering traditional therapies less effective.
• Ocular pathogens exhibit increasing resistance, leading to complications and potential permanent vision loss.

Purpose of the Study:

• To synthesize recent evidence on ocular AMR, including resistance patterns, therapeutic challenges, and management strategies.
• To focus on current resistance trends and evolving treatment approaches for bacterial, viral, fungal, and parasitic ocular infections.
• To highlight the challenges posed by multidrug-resistant organisms in ophthalmology.

Main Methods:

• Review of clinical, microbiologic, and pharmacologic studies published primarily between 2020 and 2025.
• Evaluation of reports and systematic reviews on bacterial, viral, fungal, and parasitic ocular pathogens.
• Characterization of current resistance mechanisms and management strategies across various ocular pathogens.

Main Results:

• Ocular barriers limit drug penetration, exacerbating resistance and reducing therapeutic efficacy.
• Specific resistance mechanisms identified include efflux pumps, biofilm formation (Pseudomonas), UL97/UL54 mutations (CMV), and mecA presence (MRSA).
• Multidrug-resistant Pseudomonas keratitis and CMV retinitis are leading causes of vision loss, particularly in immunocompromised patients.

Conclusions:

• Ocular AMR is an urgent and expanding clinical challenge requiring immediate attention.
• Pseudomonas aeruginosa and CMV are key multidrug-resistant organisms affecting the anterior and posterior segments, respectively.
• Addressing ocular AMR necessitates improved diagnostics, drug delivery systems, and pathogen-specific therapies to preserve vision.