title: Microsporidial keratoconjunctivitis in the tropics: a case series.
abstract: OBJECTIVE
  To present a series of microsporidial keratoconjunctivitis in 24 eyes.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Desmond
authors.initials: D
authors.lastname: Tung-Lien Quek
authors.forename: James Chuan-Hsin
authors.initials: JC
authors.lastname: Pan
authors.forename: Prabha Unny
authors.initials: PU
authors.lastname: Krishnan
authors.forename: Paul Songbo
authors.initials: PS
authors.lastname: Zhao
authors.forename: Stephen Charn Beng
authors.initials: SC
authors.lastname: Teoh