What We Can Do in Infectious Keratitis, Except for Conventional Antimicrobial‐Based Therapies: Major Narrative Review

ABSTRACT Background and Aims Infectious keratitis (IK) is classified as a critical ophthalmic emergency, with the potential to result in vision‐impairing complications. The treatment approach involves the use of pharmacological antimicrobial agents in combination with surgical interventions. Traditionally, the management of IK has relied on conventional antimicrobial agents, although the specific treatment regimen may vary based on the underlying causative agent. The growing antimicrobial resistance, along with the less favorable outcomes in most cases, emphasizes the urgent need for adjunctive or novel therapies. This report aims to provide a thorough overview of the current clinical and experimental non‐antimicrobial therapies, encompassing both medical and surgical options, whether they serve as adjuncts to antimicrobial treatments or function as independent therapies for IK. Methods A comprehensive search on PubMed was undertaken to identify relevant articles. Articles that described conventional antimicrobial‐based treatments were excluded from the review. Additionally, case reports and non‐English publications were not considered. Results Various therapeutic options, including medical‐based therapies (povidone‐iodine, matrix metalloproteinases inhibitors, corticosteroids, host defense peptides, novel small molecules, formaldehyde releasers, synthetic polymers, antioxidants, and bacteriophages), laser/light‐based therapies (photodynamic therapy, ultraviolet C light, thermal lasers, photothermal therapy, phototherapeutic keratectomy, and blue light), surgical‐based therapies (conjunctival flap and Tenon graft, corneal gluing, amniotic membrane transplantation, and keratoplasty), and miscellaneous therapies (nanomedicine and contact lens, plasma ablation, debridement, and cryotherapy) were included and discussed. Conclusion The conventional approach to managing IK involves the use of topical antimicrobial agents. Most instances can be effectively addressed with empirical treatment using antimicrobial eye drops, yielding satisfactory results. However, it seems the rise in antimicrobial resistance and insufficient response in some cases, especially fungal keratitis, necessitates ophthalmologists to utilize all currently available options in their toolbox more efficiently and intensify research efforts aimed at developing alternative therapeutic strategies.