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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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