Prompt diagnosis and treatment of fungal keratitis improve patient outcomes

A retrospective study of fungal keratitis in rural China evaluated associated risk factors, treatments, and prognoses to determine factors that could help improve patient care. Results support using eye protection during outdoor activities.

Study design

This was a retrospective review of data from 251 patients who were diagnosed with fungal keratitis in Heilongjiang Province, China, from 2017 to 2021. Medical records were retrieved to identify demographic characteristics, risk factors, clinical features, laboratory results, treatment approach, and outcomes.


The five busiest agricultural months of the year accounted for 74.1% of fungal keratitis incidences. The mean age of patients in this subset was 58.2 ± 9.5 years, and 66.7% of patients were male. In 80.1% of cases, plant-related trauma was the etiology for corneal infection, with Fusarium the most common fungal species identified (34.9%). Delayed presentation correlated with greater hypopyon size, depth of hyphae or spores, and width of infiltrate. Additionally, waiting longer to seek treatment was associated with a decreased response to antifungals and greater risk of requiring surgical intervention.


Limitations of this study include its retrospective nature, lack of a standardized data recording process, the prevalence of different fungal strains in this region in comparison to other regions around the world, and the fact that only a small number of each fungus type was represented.

Clinical significance

This study supports the use of adequate eye protection during outdoor activities in agricultural regions to help prevent fungal keratitis. In addition, it suggests that earlier treatment of fungal keratitis leads to better outcomes, so further education among farmers and local health care centers would be helpful to improve diagnosis and prognosis.

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