Fungal keratitis is a sight-threatening corneal infection affecting over a million people annually. Natamycin, a polyene extracted from
This review consolidates current knowledge on fungal keratitis, including prevalence, risk factors, and etiology. It provides a comprehensive evaluation of natamycin, covering its pharmacology, mechanism of action, antifungal spectrum, and clinical applications while addressing the limitations of conventional natamycin therapy and ocular barriers that restrict drug delivery. Furthermore, the review highlights recent advances in both nanotechnology-based and non-nanotechnology-based natamycin delivery strategies to enhance corneal bioavailability.
Despite promising preclinical outcomes in terms of bioavailability and retention, no alternative natamycin formulations have yet progressed to clinical trials or commercialization. Further efforts are required to advance these delivery systems into clinical trials and realize their potential to improve outcomes in fungal keratitis.