Clinical Features, Risk Factors, and Treatments of Microsporidial Epithelial Keratitis

Abstract

Objective: To report the clinical manifestations, risk factors, and treatments of microsporidial epithelial keratitis in Thailand. Methods: Twenty eyes of 19 patients were diagnosed and the clinical presentations, risk factors, and management were analyzed. Results: Of 19 patients, six patients (32%) had no apparent risk factors. Predisposing factors included soil exposure (6/19, 32%), water contamination (6/19, 32%), and eye liner (1/19, 4%). Twelve cases (63%) were detected in the rainy season. All cases presented with disseminated, punctated, elevated, epithelial keratitis. Corneal scrapings with Gram-chromotrope staining were positive in all patients. Moxifloxacin 0.5% eye drops were given and all 16 patients experienced complete resolution. Three recurrent cases were resolved with only topical moxifloxacin without corneal scraping or swabbing. Conclusions: Predisposing factors were not found in some patients; thus, corneal scraping with staining should be considered in cases having a high index of suspicion. The incidence is increased during the rainy season; therefore, clinicians should have more awareness during these times. Debridement with topical moxifloxacin eye drops, without any systemic medication, may be an effective treatment. Corneal scraping or swabbing may not be required in recurrences.

• Epithelial keratitis
• Gram-chromotrope stain
• microsporidia
• risk factors
• treatment

ACKNOWLEDGMENTS

The authors thank: (1) the patients for their participation; (2) the nursing and medical staff for their assistance; (3) the Department of Ophthalmology and the Faculty for financial support; and (4) Professor James A. Will for assistance with the English-language presentation.

DECLARATION OF INTEREST

This study was approved by the Ethics Committee (HE561154) of the the Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.