To prevent recurrence [25]. Depending on their initial results with ethanol, Agarwal et al. explored the efficacy of employing topical ethanol to treat PI. They performed microbiological, clinical, and histopathological research to analyze the impact of absolute ethanol on P. insidiosum in conjunction with infrared spectroscopy to assess the corneal penetration and concluded that it may very well be considered as a therapeutic alternative; even so, the exact dose and strength of ethanol at which it will likely be most efficient nonetheless needs to become explored [69]. Ethanol is recognized to reduce the viability of cells by causing cell lysis, suppressing proliferation, and inducing apoptosis. It mostly acts on the cell membranes, along with the lack of ergosterol within the cell wall of Pythium tends to make it extra susceptible to ethanol even at decrease concentrations. Determined by the reports accessible within the literature and also the author’s personal encounter managing PI keratitis, we propose a treatment algorithm taking theTable 2 Assessment of literature of clinical research and case reports of Pythium insidiosum keratitisDemography Danger factors Clinical functions Investigations Management OutcomeS.AuthorsCountryno. 42-year-old male Corneal scraping Health-related management vision 20/60 1: 45-year-old female two: 51-year-old female, and 55-year-old male 2, 3: Corneal stromal infiltrate (rRNA) gene fluconazole, enucleation, and health-related management 2: Health-related management, penetrating keratoplasty, intracameral fluconazole, enucleation three. Healthcare management, two therapeutic keratoplasties (TPK), intracameral mass spectrometry (MALDI-TOF-MS) 3: Cultured on PDA plate and confirmed by MALDI-TOF-MS 54-year-old male Peripheral ulcerative keratitis Pythium was confirmed by zoospore formation and DNA sequencing; histopathology showed filaments Healthcare management (topical vancomycin and ciprofloxacin) and topical and oral corticosteroids worsened the illness; later, TPK. Healthcare management of Pythium was started amphotericin B, enucleation sequencing with pan 3: received diagnosis of viral keratitis, had fungal primers (ITS1/ ITS4) 2: Corneal scraping, Gram staining, KOH, culture, potato dextrose agar (PDA), Subculture within the brain eart infusion, matrix-assisted laser desorption ionization-time of flight keratoneuritis mimicking Acanthamoeba ribosomal RNA intracameral 3: Endophthalmitis and enucleation 2: Exposure to cigarette ash 1: Corneal ulcer (ring infiltrate) 1: Corneal scraping, confocal microscopy, 1: Keratectomy, lamellar keratoplasty, 1, three: Exposure to river water 1: Enucleation two: Enucleation COVID-19 (35 days soon after COVID-19) Left eye had corneal ring infiltrate (four 9 4 mm), Resolved in 14 daysRoy et al.CD79B Protein Species [74]IndiaOphthalmol Ther (2022) 11:1629Hou et al.IFN-gamma, Mouse (HEK293) [75]ChinaKate et al.PMID:23771862 [31]IndiaTable 2 continuedDemography Risk elements Clinical features Investigations Management OutcomeS.AuthorsCountryno. four males, 2 females, imply age in Dry surface of your corneal ulcer, satellite lesions, There was a poor response to antifungal drugs. All sufferers received keratoplasties. Recurrence was noted in 3 patients [4 days after the first surgery and 2 days soon after the second surgery 18 patients (15 males, three Agricultural injury, All sufferers had unilateral involvement. Corneal ulcer with tentacle-like extension, reticular dotlike infiltrates, feathery margins, ring infiltrates, corneal perforation, hypopyon, peripheral corneal thinning, descemetocele, blurred or irregular ulcer margins iodine-potassium iodide-sulfuric acid: one hundred positivity, period.