Actinomyces odontolyticus keratitis: an emerging opportunist in ocular surface diseases

To describe the risk factors, clinical and microbiological profile, management, and outcomes of Actinomyces odontolyticus-associated keratitis in a retrospective case series from a tertiary eye care center in South India.

A retrospective analysis was conducted on seven patients with culture-proven Actinomyces odontolyticus keratitis at the LV Prasad Eye Institute, Hyderabad, between January 2024 and April 2025. Demographic data, clinical features, risk factors, microbiological findings, treatment course, and outcomes were reviewed.

Of the seven patients, five (71%) had pre-existing ocular surface abnormalities, including non-healing epithelial defects (PED) post therapeutic penetrating keratoplasties, spheroidal degeneration, and chemical injury. Six out of seven (86%) had a pre-existing PED before they developed keratitis. Four had undergone prior ocular surgeries and were on long-term topical corticosteroids (average duration 53 days). Corneal ulcers had a median size of 2.7 (IQR,1.5-4.5 mm). Five out of 7 patients responded to topical fortified cefazolin 5%, with complete resolution of infection. The average duration of medical therapy was approximately 72 days (15-150 days). Two patients required adjuvant interventions, including cyanoacrylate glue, bandage contact lens, and anterior chamber reformation for corneal perforation. Three patients underwent optical penetrating keratoplasty. The remaining four had satisfactory outcomes with medical management alone. Final best-corrected LogMAR visual acuity ranged from 2.4 to 0.40 at the last follow-up.

Actinomyces odontolyticus keratitis, though uncommon and often underrecognized in compromised eyes, can cause a non-healing epithelial defect and can be effectively managed with timely microbiological evaluation and appropriate antibiotic therapy.