The evolving landscape of fungal keratitis: from emerging pathogens to precision diagnostics and novel therapeutics

Fungal keratitis (FK) remains a major cause of vision-threatening corneal infection, especially in tropical and subtropical regions, with an expanding epidemiological spectrum driven by environmental, climatic, occupational and host-related factors. Fusarium and Aspergillus were the most common pathogens reported. Greater etiological diversity is reflected by increasing recognition of dematiaceous fungi, uncommon molds, and cryptic species. The literature search was performed by searching bibliographic databases (PubMed and Google Scholar), covering publications from January 2000 to August 2026. Additional relevant studies were identified by screening the reference lists of key publications. This review provides an overview of the current state of FK including changing epidemiology, established diagnostic approaches, emerging technologies, and evolving therapeutic approaches. Conventional microscopy and culture remain central to diagnosis, with molecular methods, sequencing, MALDI-TOF and noninvasive imaging offering advantages in sensitivity, speed and species-level identification. Novel diagnostic methods such as CRISPR-based tests, genome sequencing, artificial intelligence, biosensors and point-of-care diagnostics may provide rapid and accessible precision diagnosis. Therapeutic challenges include poor corneal drug penetration, antifungal resistance and prolonged treatment. Hence, the exploration of new antifungals, nanotechnology-based delivery systems, photoactivated therapies and antimicrobial peptides. These advances support a transition to integrated, rapid and precision-based management of FK collectively.