Rise in incidence of opportunistic Candida keratitis in the post-COVID era.

Background To analyze the evolving trend of Candida keratitis across COVID, early post-COVID and late post-COVID eras. Main text: This retrospective study reviewed electronic medical records of patients diagnosed with Candida keratitis at a tertiary eye care center at Bhubaneswar between January 2020 and August 2025. The study period was categorised into COVID era (2020–2021), early post-COVID era (2022–2024), and late post-COVID era (2025). As per institutional protocol for investigation of microbial keratitis, corneal scrapings were collected from all patients and subjected to direct microscopy and culture for bacteria, fungi and Acanthamoeba . Corneal scraping from 6,294 suspected microbial keratitis patients were received during study period, of which 63 (1.0%) were found infected with Candida spp. The data distribution includes 0.3% (3/997 total cases) in 2020, 0.5% (5/1003 total cases) in 2021, 1.6% (16/1,019 total cases) in 2022, 1.4% (17/1238 total cases) in 2023, 1.2% (15/1270 total cases) in 2024 and 0.9% (7/767 total cases) in 2025. We found 26 (41.3%) patients having history of earlier immune suppression either systemically or locally suffered from Candida keratitis while 37 (58.7%) patients not having any history of systemic/ local immune suppression also suffered from Candida infection. Conclusion Candida keratitis demonstrated a rising trend in the early post-COVID era compared to COVID era possibly due to prior history of immune suppression followed with SARS-CoV-2 infection in few patients and altered host immunity following SARS-CoV-2 infection in rest of immunocompetent patients. Increased awareness of this emerging trend among Ophthalmologists may facilitate early diagnosis.