The therapeutic potential of medicinal mushrooms in ophthalmology: from ethnomycology to evidence-based applications.

Medicinal mushrooms have long been used in traditional medical systems, yet their ophthalmic relevance has only recently been explored. This narrative review provides, to our knowledge, an integrative mapping of medicinal mushroom-derived bioactive compounds in ophthalmology, with particular emphasis on their level of evidence across different ocular diseases. A structured search of PubMed, Scopus, Google Scholar and ScienceDirect (2001-2026) was conducted to identify experimental, clinical, and mechanistic studies addressing antioxidant, anti-inflammatory, immunomodulatory, neuroprotective and antifibrotic pathways in ocular tissues. The findings reveal a marked heterogeneity in evidence levels. A limited subset of fungal-derived compounds - primarily antimicrobial and immunomodulatory agents such as β-lactam antibiotics, cyclosporine A, and mycophenolate mofetil - are supported by high-level clinical evidence (Level 1), while emerging evidence (Level 2) is available for compounds such as Isaria cicadae in dry eye disease and Ganoderma lucidum in age-related macular degeneration. In contrast, the majority of medicinal mushrooms - including Pleurotus spp., Hericium erinaceus, Wolfiporia extensa, and Polyporus umbellatus - remain supported mainly by preclinical studies and traditional use (Level 5 evidence). Experimental data indicate that mushroom-derived polysaccharides and triterpenoids can modulate oxidative stress, inflammation, intraocular pressure, fibrosis, and neuronal survival. Additional compounds demonstrate potential in glaucoma, cataract, and retinal disorders through multitarget mechanisms. Overall, medicinal mushrooms represent a promising but still under-validated therapeutic resource in ophthalmology. The observed disparity between traditional use, experimental evidence, and clinical validation highlights a significant translational gap, underscoring the need for standardized formulations and well-designed clinical trials to enable evidence-based integration into ophthalmic practice.