**1. Introduction**

Infectious keratitis is an inflammation of the cornea caused by microorganism. It is most commonly associated with bacterial, fungal or viral microorganisms that invade into the corneal stroma, resulting in inflammation and destruction of these structures; ultimately leading to visual impairment and blindness. Fungal keratitis (FK) or keratomycosis is one of the most challenging to diagnose and difficult to treat. The prevalence of fungal keratitis is variable depending upon the geographic location. It is more common in tropical and subtropical areas and relatively rare in temperate countries. It is reported about 1–60% of all cases of microbial keratitis in various studies [1–3]. A recent review including 37 countries reported highest proportion in Vietnam (59.58%) followed by Paraguay (58%) [2–4]. The fungi that commonly cause infection of the cornea include Fusarium, Aspergillus, Curvularia, Bipolaris, and Candida [1, 2, 5].

Most of the currently available antifungal medications have limitations, such as poor bioavailability and limited ocular penetration, especially in cases with deep keratitis [6–8]. This results in slow resolution of fungal infections. In addition, fungi can penetrate deeper into corneal stroma and Descemet membrane, therefore more difficult to eradicate. Surgical excision of the infected cornea is required to control the infection in nonresponsive cases [9–12]. In recent years, considerable research is being continue in the field of management of fungal keratitis and several newer antifungal agents and drug delivery techniques are being evolved to overcome these limitations and improve outcome. In this chapter, we discuss the recent advances in diagnosis and treatment of fungal keratitis with a brief discussion on pathogenesis and future considerations.
