-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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