Microsporidial Keratitis

• Microsporidia is a spore-forming unicellular organism.

• Can affect ocular tissues & cause epithelial keratoconjunctivitis, deep stromal keratitis, scleritis & endophthalmitis.

• They are waterborne opportunistic pathogens & spread through contaminated water like lake water, swamp water, swimming pool water, or spring water.

HISTORY:

• Redness, decreased visual acuity, watering, lid swelling, and foreign body sensation following exposure to contaminated water

• Unilateral/ Bilateral

CLINICAL FEATURES:

• Multiple fine to coarse punctate, raised epithelial corneal lesions (stuck on appearance).

• The lesion stains variably with fluorescein & can be distributed peripherally, paracentrally, or diffusely.

• In stromal microsporidial keratitis, there is a history of multiple episodes of remission and recurrence.

• The corneal infiltrates are multifocal, mid to deep stromal, and often with intact overlying epithelium. -The stromal infiltrates are non-specific and associated with stromal edema with or without deep stromal vascularization.

GRADING:

• Grade 1: greyish white and <10 in number and largely distributed in the peripheral cornea.

• Grade 2: lesions are central 10-20 elevated epithelial lesions.

• Grade 3: central lesions 21 to 40 in number.

• Grade 4: lesions are largely peripheral and have subepithelial infiltrates.

DIAGNOSIS:

• Mainly clinical

• Corneal scraping - Microsporidia spores stain well with Gram stain, silver stain, and 10% KOH with 0.1% calcofluor white.

MANAGEMENT:

• Debridement of corneal epithelium - debridement does not have an additional advantage over conservative management as far as the resolution of lesions is concerned.

• Topical fluoroquinolones

• PHMB 0.02% and chlorhexidine gluconate 0.02% are the biguanides found effective in treating microsporidial keratitis when combined with debridement.

• Sub-epithelial infiltrates: topical steroids with steroid-sparing agents

• For corneal stromal microsporidiosis: TPK

D/D:

• Adenoviral keratoconjunctivitis

• Thygeson superficial punctate keratitis

• Superficial punctate keratitis

• Filamentary keratitis

• Herpes simplex virus epithelial keratitis

• Acanthamoeba keratitis

• Atypical mycobacterial keratitis

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