Infectious Keratitis in Sub-Saharan Africa: Microbiological Issues, Delayed Diagnosis and the Role of Patient Education

Abstract

Introduction: Infectious keratitis (IK) is a major cause of preventable corneal blindness, disproportionately affecting populations in sub-Saharan Africa (SSA). The visual prognosis is often clouded by complex challenges, including a specific microbiological profile, frequent diagnostic delays, and gaps in overall patient management. This narrative review aims to synthesise current knowledge on microbiological issues, factors contributing to delayed diagnosis, and the potential role of patient therapeutic education (PTE) in improving clinical outcomes for IK in SSA. Methods: A narrative review of the literature was conducted by consulting the PubMed and Google Scholar databases and institutional archives (HAL, DUMAS). Keywords included ‘infectious keratitis,’ ‘corneal ulcer,’ ‘sub-Saharan Africa,’ ‘fungal keratitis,’ ‘delayed diagnosis,’ and ‘patient therapeutic education.’ Relevant articles published up to January 2026, dealing with the epidemiology, aetiology, diagnosis and management of IK in SSA, were included. Results: The literature confirms that SSA has a high incidence of IK, with a marked predominance of fungal keratitis (FK), often linked to agricultural trauma. Bacterial pathogens, particularly *Pseudomonas aeruginosa* and *Staphylococcus aureus*, also remain prevalent. Delayed diagnosis is a major multifactorial problem, fuelled by socio-economic and geographical barriers, the use of self-medication and traditional medicines, and limited diagnostic capabilities (lack of access to corneal scraping and culture). Although recognised as a potential lever for improving compliance and prevention, ETP remains largely unstructured and undocumented in the region. Conclusion: Infectious keratitis in sub-Saharan Africa is a major public health problem, characterised by high incidence, a microbiological profile dominated by post-traumatic fungal and bacterial infections, and devastating visual consequences. This narrative review of the literature has highlighted the interconnected factors that explain the severity of this condition in the region. Delayed consultation, fuelled by geographical, economic and socio-cultural barriers, as well as the frequent use of dangerous traditional eye medicines, is the main determinant of poor prognosis.