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To determine the incidence, causative organisms, and treatment effectiveness for microbial keratitis (MK) in the Southwest of England. Retrospective analysis of 872 corneal scrapes (January 2018–December 2022). Microbiology results were evaluated for organism growth and antimicrobial sensitivity. Data were divided into two groups for trend analysis (A: 2018–2020, B: 2021–2022). Of the 872 scrapes, 357 (39.6%) were culture positive. Bacteria accounted for 90.2% of cases, followed by viruses (2.8%), fungi (2.5%), mixed bacterial growth (2.5%), and Acanthamoeba (2.0%). The estimated incidence of MK was 9.69/100,000/year. Group B had a significantly higher overall MK incidence, with no change in pathogen distribution. Pseudomonas aeruginosa was the most frequent isolate (69 cases, 19.3%). In vitro sensitivity to fluoroquinolones was 94.4% for Gram-positive and 98.6% for Gram-negative bacteria. All fungal isolates were sensitive to at least one antifungal. Bacterial pathogens dominate MK in the Southwest of England, with over 90% sensitivity to chloramphenicol, fluoroquinolones, and aminoglycosides, indicating low antimicrobial resistance. Fluoroquinolones remain the recommended first-line therapy for MK. Fungal and protozoal keratitis are rare (