Microsporidial Keratoconjunctivitis in the Tropics: A Case Series
Desmond Tung-Lien Quek1, James Chuan-Hsin Pan2, Prabha Unny Krishnan3, Paul Songbo Zhao2, Stephen Charn Beng Teoh*, 2
1 Singapore National Eye Centre, Singapore
2 Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
3 Department of Pathology and Laboratory Medicine, Tan Tock Seng Hospital, Singapore
To present a series of microsporidial keratoconjunctivitis in 24 eyes.
Retrospective non-comparative observational case series. Medical records were retrieved and individuals evaluated based on symptoms, risk factors, visual acuity, slit lamp biomicroscopy and pathological examination of cornea epithelial scrapings. Demographic features, clinical course, predisposing factors, microbiological profile, treatment, final clinical outcome and visual acuity were recorded.
Of the 22 patients, 90.9% were men, with a mean age of 30.3 years (range 15 – 76 years). Two (9.1%) had bilateral involvement, 15 (68.2%) were non-contact lens users, 17 (77.3%) reported contamination with mud within 2 weeks (mean 6.8 days) of onset of symptoms. All patients presented with conjunctivitis and coarse, multifocal, punctate epithelial keratitis. Two out of 24 eyes (8.3%) had anterior stromal infiltrates, while 8 (33.3%) had anterior uveitis. Microsporidial spores were identified on modified trichrome staining of corneal epithelial scrapes in all eyes. All eyes were treated with epithelial debridement, topical fluoroquinolone and hexamidine diisethionate, 7 (31.8%) patients received oral albendazole, and all eyes with anterior uveitis received topical steroids. All cases resolved without visually significant sequelae.
Microsporidial keratoconjunctivitis occurred mainly in males, is usually unilateral, presents as conjunctivitis and coarse, multifocal, punctate epithelial keratitis, and may incite anterior uveitis. Soil contamination is an important risk factor. Treatment with debridement, fluoroquinolones, hexamidine diisethionate with or without systemic albendazole is effective, with steroids reserved for any associated anterior uveitis.
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* Address correspondence to this author at the Department of Ophthalmology, Tan Tock Seng Hospital. 11 Jalan Tan Tock Seng, 308433, Singapore; Tel: 6357 8006; Fax: 6357 8675; E-mails: Stephen_Teoh@ttsh.com.sg, email@example.com