ORIGINAL PAPER Clinical and epidemiological characteristics of infectious keratitis in Paraguay Martin M. Nentwich • M. Bordo ´n • D. Sa ´nchez di Martino • A. Ruiz Campuzano • W. Martı ´nez Torres • F. Laspina • S. Lichi • M. Samudio • N. Farina • Rosa R. Sanabria • Herminia Mino de Kaspar Received: 12 May 2013 / Accepted: 17 April 2014 Ó Springer Science+Business Media Dordrecht 2014 Abstract To describe the clinical and epidemiolog- ical characteristics of patients with severe infectious keratitis in Asuncio ´n, Paraguay between April 2009 and September 2011. All patients with the clinical diagnosis of severe keratitis (ulcer C2 mm in size and/ or central location) were included. Empiric treatment consisted of topical antibiotics and antimycotics; in cases of advanced keratitis, fortified antibiotics were used. After microbiological analysis, treatment was changed if indicated. In total 48 patients (62.5 % males, 25 % farmers) were included in the analysis. A central ulcer was found in 81.3 % (n = 39). The median delay between onset of symptoms and time of first presentation at our institution was 7 days (range 1–30 days). Fungal keratitis was diagnosed in 64.5 % (n = 31) of patients, of which Fusarium sp. (n = 17) was the most common. Twenty-one patients (43.8 %) reported previous trauma to the eye. The globe could be preserved in all cases. While topical therapy only was sufficient in most patients, a conjunctival flap was necessary in six patients suffering from fungal kera- titis. The high rate of fungal keratitis in this series is remarkable, and microbiological analysis provided valuable information for the appropriate treatment. In this setting, one has to be highly suspicious of fungal causes of infectious keratitis. Keywords Antibiotics Á Epidemiology Á Infectious keratitis Á Fungal keratitis Introduction Severe infectious keratitis is a serious, potentially sight-threatening condition, which requires prompt treatment. Corneal opacities still represent important causes of global visual impairment (1 % of all visually impaired people worldwide) and blindness (4 % of all blind people worldwide) [1]. Corneal ulceration may even be responsible for 1.5–2.0 million new cases of monocular blindness annually [2]. The distribution of microorganisms responsible for infectious keratitis varies depending on the geographic region. A recent review article found the highest proportion of bacterial corneal ulcers in studies from North America, Australia, the Netherlands, and Sin- gapore, while the highest proportions of fungal infections were seen in studies from India and Nepal Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), May 2012, Fort Lauderdale, USA. M. M. Nentwich (&) Á H. M. de Kaspar Department of Ophthalmology, Ludwig-Maximilians- University, Mathildenstr. 8, 80336 Munich, Germany e-mail: martin.nentwich@med.uni-muenchen.de M. Bordo ´n Á D. S. di Martino Á A. R. Campuzano Á W. M. Torres Á F. Laspina Á S. Lichi Á M. Samudio Á N. Farina Á R. R. Sanabria Fundacio ´n Banco de Ojos ‘‘Fernando Oca del Valle’’, Instituto de Investigaciones en Ciencias de la Salud, Asuncio ´n, Paraguay 123 Int Ophthalmol DOI 10.1007/s10792-014-9951-7