Fungal infections of the eye, especially fungal keratitis and endophthalmitis, are major causes of concern and if left untreated could lead to vision loss. Currently, natamycin (polyene antifungal) is the only commercially available topical agent used for the treatment of ocular fungal infections. The other antifungals, belonging to the polyene and azole classes, are used off-label in treating ocular infections and are administered topically, orally, intraocularly, or systemically. Even though their use through the different routes of administration has shown favorable outcomes, challenges such as poor ocular penetration, low bioavailability, ocular toxicity, and systemic side effects limit their utility. Hence, in search of alternative strategies, the echinocandin class of antifungals are currently being assessed for their use in ocular infections. Their evaluation in the ophthalmic arena has been propelled by their efficacy, safety, and tolerability reports in the treatment of systemic invasive fungal infections. This review compiles the reports on the ocular investigations of the 3 commercially available echinocandins-caspofungin, micafungin, and anidulafungin-to understand their potential as ocular antifungal agents.
Keywords: antifungal therapy; echinocandins; fungal endophthalmitis; fungal keratitis.