Bacterial keratitis: a global review of current practices, challenges and innovations

Bacterial keratitis is a major cause of corneal blindness worldwide, with marked differences in clinical presentation and risk factors across regions. In high-income countries, contact lens use is the leading risk factor, while in low- and middle-income countries, trauma-related infections are more prevalent. Management relies on timely diagnosis and sensitivity-guided topical antibiotic therapy. Staphylococcus and Streptococcus species are the most frequently isolated Gram-positive organisms, while Pseudomonas aeruginosa is the leading Gram-negative pathogen, especially in contact lens-related cases. Rising antimicrobial resistance complicates care and underscores the importance of performing corneal scraping to ascertain microbiological identification, particularly in severe infections. Fluoroquinolone resistance is increasing among both Gram-positive and Gram-negative isolates. The primary goals of treatment are to eliminate infection, control inflammation, preserve corneal structure and ultimately restore vision. Prompt initiation of antibiotics is essential following microbiological sampling. Conventional diagnostic methods are increasingly complemented by molecular tools such as PCR. Next-generation sequencing offers the potential for unbiased, comprehensive pathogen identification though calibration is needed before clinical implementation. Deep learning-based systems show promise in supporting diagnosis through automated image analysis. Several new antibiotics, primarily fluoroquinolones, may help address multidrug-resistant infections pending clinical validation for ophthalmic use. Primary prevention remains central to reducing disease burden through contact lens hygiene education and simple, low-cost prophylactic measures after corneal trauma.