2. • 29 years
• Male
• Pondicherry
• Manager, pharmaceutical company
CASEI
3. • Redness
• Watering
• Blurring of vision
• Photophobia
CHIEF COMPLAINTS
Left eye x 10 days
4. HISTORY OF PRESENT ILLNESS
Patient was apparently alright 10 days ago when he noticed
redness, watering, blurring of vision and photophobia in left eye on
waking up in the morning
No complaint of ocular discharge, cough, cold or skin vesicles
Consulted Vasan eye care where eye drops moxifloxacin and
carboxymethylcellulose were prescribed - no relief
5. No history of:
• Ocular trauma or foreign body
• Contact lens wear
• Long term use of any eye drop or other medication
• Diabetes mellitus
• Any other chronic systemic illness
8. OCULAR EXAMINATION
OD OS
BCVA 6/5, N6 6/12, N10
NCT 9 mm Hg 10 mm Hg
Lids Normal Edematous
ROPLAS Negative Negative
Conjunctiva Normal
Congested
No papillae or follicles
No foreign body
Sclera Normal Normal
9. Cornea Clear
• Multiple superficial punctate grey-white
epithelial infiltrates <1mm with distinct
margins over central cornea
(fluorescein stain+)
• Few subepithelial infiltrates
• No keratic precipitates
• Sensation normal
13. Anterior
chamber
Normal depth & quiet Normal depth & quiet
Iris Normal Normal
Pupil
Round,
normal reaction to light
Round,
normal reaction to light
Lens Clear Clear
Fundus
Cup:Disc ratio = 0.3:1
Healthy neuroretinal rim
Macula & blood vessels
normal
Cup:Disc ratio = 0.2:1
Healthy neuroretinal rim
Macula & blood vessels
normal
18. • Few healthy and degenerated epithelial cells
• Few pus cells
• Fibrinous exudates
• No bacterial agent could be made out
Narayana Nethralaya Laboratories, Reference number: N33711
26. • Tablet Albendazole 400 mg OD x 7 days
Left eye
• Eye ointment Neosporin® (Neomycin, Bacitracin & Polymyxin B)
QID x 20 days
• Eye drop Flurometholone 0.1% QID x 5 days
TDS x 5 days
BD x 5 days
OD x 5 days
TREATMENT
27. FOLLOW UP AT 1 WEEK
• Symptomatic improvement
• Decreased conjunctival congestion
• Reduced corneal epithelial and subepithelial infiltrates
31. No history of:
• Ocular trauma or foreign body
• Long term use of any eye drop
• Contact lens wear
• Diabetes mellitus
• Any chronic illness
Consulted a private practitioner - prescribed eye drop
Ciprofloxacin + Dexamethasone - no improvement
40. • Protozoa. Recent studies: related to kingdom fungi
• 3.5-5 µ x 2-3 µ
• True nucleus, prokaryotic-like ribosome, lacks mitochondria
• Spore forming
• Obligate intracellular parasite –
vertebrates and invertebrates
• First recognised - 1857
• First reported - 1973, vascularised
corneal scar
Alkatan HM, Al-Zaaidi S, Athmanathan S. Microsporidial keratitis. Saudi J Ophthalmol. 2012
Apr; 26(2): 199–203
41. • Gastrointestinal tract
• Eye
• Lung
• Kidney
• Sinus
• Immunocompromised
• Increased prevalence of HIV infection - more case reports of
microsporidiosis
42. 1200 species identified. 12 cause human infection.
Family Genera Species
Microsporidia Microsporidium
M. ceylonensis
M. africanum
Encephalitozoonidea Encephalitozoon
E. cuniculi
E. intestinalis
Nosematidea
Nosema
N. ocularum
N. connori
Brachlola
B. algerae
B. vescularum
Enterocytozoonidae Enterocytozoon E. bleneusi
Pleistophoridea Trachipleistophora
T. hominis
T. anthopophthera
anthopophtheraSource: Chaudhari Z, Vananthi M. Postgraduate ophthalmology. 2012; 539.
43. Recent outbreak in different parts of world:
• Increased awareness
• High level of suspicion
• Precise knowledge of disease
• Better diagnostic methods
Microsporidiosis
outbreak