Purpose <p>We evaluated the epidemiology, clinical features, microbiology, management and visual outcome of <i>Streptococcus pneumoniae</i> keratitis.</p> Methods <p>We retrospectively reviewed the medical charts of patients diagnosed with culture-proven <i>Streptococcus pneumoniae</i> keratitis in a French tertiary center between January 2015 and December 2020.</p> Results <p>We analyzed data from 51 eyes of 51 patients with <i>Streptococcus pneumoniae</i> keratitis followed for 64 (19–105) days, out of a total of 1222 eyes with documented bacterial keratitis (4.17%). Most cases (55%) occurred in winter or spring (<i>p</i> = 0.037). A local or systemic risk factor was identified in 39 (76%) and 32 (63%) eyes respectively: previous ocular surgery (55%) followed by glaucoma (24%), and diabetes (18%). Forty-one patients (80%) with severe keratitis remained in hospital for 7 (1–60) days. Polymicrobial infection was detected in 6 eyes (12%) and multidrug resistant strain in 9 eyes (18%). Medical treatment lasted 36 (21–60) days. Adjuvant surgery was required in 13 eyes (25%) mainly for delayed ulcer healing (<i>n</i> = 10), with amniotic membrane transplantation (<i>n</i> = 12) or tectonic keratoplasty (<i>n</i> = 1). In multivariate analysis, endothelial plaque (OR 65.87, <i>p</i> = 0.028), hypopyon (OR 17.8, <i>p</i> = 0.040), and infiltrate &gt; 5mm² (OR 2.49, <i>p</i> = 0.012) were significantly associated with the need for adjuvant surgery. Baseline visual acuity (VA) 2.00(1.33-2.00) logMAR did not improve significantly at final visit (<i>p</i> = 0.121). Eyes requiring adjuvant surgery had worse final VA (<i>p</i> = 0.009).</p> Conclusion <p><i>Streptococcus pneumoniae</i> keratitis are rare in France but may be sight-threatening. Overall VA is poor, most of patients require hospitalization, and some local factors at presentation predict the need for adjuvant surgery.</p>