Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis

Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the anti-biotic era. Although, we have expeditiously developed our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts required for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we provide an overview of the established diagnostic techniques and therapeutics for keratitis caused by various bacteria. We extensively report the recent in-roads through novel tools for accurately diagnosing mono-and poly-bacterial corneal infections. Furthermore, we outline the recent progress by our groups and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discuss in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.

Automated summary

Bacterial keratitis remains one of the leading causes of corneal blindness, and knowledge gaps hinder early and accurate diagnosis and management. The complex regulatory networks, unique virulence factors, and rapid secretion of harmful proteins and toxins in bacteria make treatment challenging. This review provides an overview of diagnostic techniques and therapies for bacterial keratitis, recent advancements in accurately diagnosing mono- and poly-bacterial corneal infections, and understanding antibiotic resistance at the sub-cellular genomic level. The development of novel therapies and drug delivery systems for bacterial keratitis management is also discussed.