We caught up with Dr Beth Mills, IRR Group Leader, to tell us about her research in microbial keratitis. What is microbial keratitis? Microbial keratitis is a leading cause of blindness worldwide, and it results from an infection of the cornea, which is the transparent window on the front of your eye. It affects over 2 million people worldwide each year.What's the infection process? Bacteria, fungi or another microorganism will get into your eye through a scratch or a contact lens. The microorganism will then grow within the tissue, whilst triggering your own host immune response that comes in to try and fight the infection. This immune response simultaneously also damages the eye tissue. How do you test for it?The first step in diagnosis is to get the sample by scraping the cornea with an unpleasant and invasive needle or blade. This sample can then be added to nutrient agars to grow, or it can be used for microscopy where a dye is added. In both cases, these have been around for over a hundred years and haven’t advanced. These tests are slow and non-specific and they fail in over 50% of cases. How do you treat it? The current treatment is to add an antimicrobial to the eye hourly for days, weeks or months. This will only treat the pathogen and not the inflammatory response, and 15% of cases will require a corneal transplant. If you're in the UK with a fungal infection, you'll be hospitalised for an average of 19 days to receive this treatment, because it's so laborious.Can you tell us about your research? Our research goals are ultimately to improve patient outcomes. We're doing this by better trying to understand the disease process, develop new diagnostics like lateral flow devices, and new treatment approaches that will target your own host immune response, that will stop some of the tissue damage and scarring. We do all of this working with our partner, the Aravind Eye Care System, who are based in India, to make sure that the work we're doing is challenge-led and will be impactful to support the patients who need this the most.Can you tell us about your recently published book chapter?We discuss fungal keratitis, an infection of the eye’s cornea caused by fungi like yeast, or filamentous fungi. It’s a major cause of vision impairment, blindness, and eye-loss worldwide. While often seen as a “neglected tropical disease,” recent evidence shows that fungal keratitis cases are increasing in places like the UK. The review looks at how fungal keratitis develops, focusing especially on fungal biofilms—which are clusters of fungal filaments (hyphae) that stick together and protect the fungi. The review also explores how contact lenses can help spread the infection and examines lab and clinical studies on the disease.We highlight current treatments and new strategies aimed at breaking down these protective biofilms. These include new ways to deliver drugs, treatments that alter the immune system, and therapies that use light to kill fungi. Our main summary points are below:There is no clear, standard definition or test for confirming fungal biofilms. This makes it hard to compare results from different studies and has caused some contradictory conclusions.Not all fungi taken from infected patients form biofilms in the lab, and doctors currently do not consider biofilm presence when diagnosing or treating fungal keratitis.Many contact lens cleaning solutions don’t effectively kill fungal filaments, and manufacturers are not legally required to test their products against fungi.New and better treatments for fungal keratitis are urgently needed.Whether a fungus can form a biofilm is important because biofilm-forming fungi can alter your immune response and resist common treatments, making infections harder to cure.Going forward, understanding if the infecting fungus forms a biofilm could help doctors choose better treatment plans and drive the development of innovative therapies to improve patient outcomes.Global equality Dr Beth Mills is also passionate about global equality. When in-person classes were suspended during the 2020 lockdown, Akpan Friday, a student from Nigeria, reached out on social media seeking support to continue his and his classmates’ learning. Beth responded and began delivering free online lectures to the students. Although they have yet to meet in person, their relationship has developed into a mentor–mentee partnership. Both shared their positive story via the ‘Microbiology Society’ podcast, which can be found at the link below. Mills research group Dr Beth Mills at the Edinburgh Science FestivalMicrobiology Society podcast on SoundcloudAravind Eye Care System Tags CIR This article was published on 2025-06-18
