Fungal keratitis, epidemiology and outcomes in a tropical Australian setting

Background: Fungal keratitis is an ophthalmic emergency that can cause visual impairment and blindness. We reviewed the epidemiology and clinical features of fungal keratitis in a tropical Australian setting. Objectives: To document the clinical and microbiological characteristics of fungal keratitis in an Australian tropical setting. Methods: A retrospective cohort study of patients with fungal keratitis from October 2014 to December 2022 was conducted at Royal Darwin Hospital, Northern Territory, Australia. We reviewed all patients with culture-proven fungal keratitis and their outcomes. Results: There were 31 patients identified. Aboriginal and Torres Strait Islander (ATSI) patients were of a significantly younger median age (28 years) compared to non-ATSI patients (42 years), and they also presented later to health care. Contact lens use and ocular trauma were the most common predisposing factors. Most patients presented with a corneal infiltrate and corneal epithelial defect, and the central visual axis was affected in 54% of patients. 'Curvularia' spp. and 'Fusarium' spp. were the commonest causative fungi (39% and 30% respectively). Conclusions: Our series is different and reveals a wider range of fungal species identified over the 7 years of the study, in particular, a range of 'Curvularia' spp. were detected. Access to eye health services in rural and remote settings is important, particularly for ATSI patients, as morbidity remains high.