Immunotherapy in Ocular Fungal Infections: Advances and Emerging Strategies

Ocular fungal infections, represent a significant global health burden, particularly in tropical and subtropical regions. Conventional antifungal therapies often suffer from poor ocular bioavailability, delayed diagnosis, toxicity, and limited efficacy, especially in immunocompromised individuals. Given the critical role of host immunity in determining disease outcomes, immunomodulation has emerged as a promising adjunctive strategy to enhance antifungal defense while mitigating immunopathology. This review highlights the complex interplay between innate and adaptive immune responses in ocular fungal infections and explores emerging immunotherapeutic approaches such as host defense peptides, cytokine therapies (e.g., IFN-γ, IL-6, IL-17, IL-33), cellular therapies (e.g., MSCs, CAR-T cells, dendritic cells), and extracellular vesicle-based interventions. Despite existing challenges including the complexity of ocular immunopathology and the logistical hurdles of clinical trials Immunomodulatory therapies have the potential to shift the current treatment paradigm for ocular fungal infections, advancing from traditional pathogen-targeted approaches to more precise, host-directed interventions.