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Pythium insidiosum  is an important cause of infectious keratitis from tropical and sub-tropical countries. Due to its closely mimicking clinical and microbiological features with fungus, it remained unidentified and managed as fungal keratitis for a long time. Previously all patients had poor outcomes with antifungal therapy and needed surgical treatment with higher rates of recurrences of infection leading to loss of an eye. Thus, a novel approach was required to treat it and, in this article, we would like to elaborate on the drastic change which these 5 years have brought in the management of this condition. In view of making a consolidated article comprising all the required information and also our clinical experience in the management of  Pythium  keratitis, we extensively reviewed several articles available on it over PubMed and Google scholars. Relevant literature describing details about  Pythium , its clinical correlation, and recent advances from 52 articles including 12 articles from our group were finally included. Our group identified and highlighted the unique clinical and microbiological features of  Pythium insidiosum , performed several  in-vitro, in-vivo  studies along with clinical trials, and proposed the strategic way of its diagnosis and treatment. The use of antifungals was replaced with antibacterial medications and this resulted in better medical and surgical outcomes. The diagnosis and management of Pythium insidiosum is constantly evolving with several recent works pointing out the possible changes in the practice patterns for the management of this challenging form of keratitis.

Pythium insidiosum keratitis: Review of literature of 5 years’ clinical experience at a tertiary eye care center