Updates in mycobacterial keratitis diagnosis and treatment

Mycobacterial keratitis is an uncommon but challenging form of infectious keratitis, often associated with postsurgical eyes. Clinical presentation is variable and may be difficult to recognize, resulting in delays in diagnosis and challenges in management. Traditional diagnostic techniques from corneal scrapings are limited by slow organism growth and may yield negative results. Treatment is challenging due to antimicrobial resistance and typically requires prolonged multidrug therapy. Advances in diagnostic modalities, antimicrobial therapies, surgical approaches, and adjunctive treatments such as corneal crosslinking have improved clinicians' ability to mitigate or avoid severe visual consequences. Despite these developments, optimal management strategies remain incompletely defined, and outcomes continue to vary widely. This review highlights clinical presentations and diagnostic techniques, including slit-lamp images and microbiologic findings from patients at our institution, and discusses emerging technologies such as polymerase chain reaction. We also review the existing literature on NTM keratitis to inform clinical practice, with a focus on medical therapies, surgical management, and newer photodynamic treatment approaches. This review aims to provide a comprehensive framework to support earlier diagnosis and guide more effective management of NTM keratitis.