Objective:

To report a case of bilateral microsporidial keratoconjunctivitis in a pediatric patient and highlight the need to consider microsporidial infection in persistent keratoconjunctivitis unresponsive to conventional therapy.

Approach:

• Patient Presentation: A 9-year-old female presented with a 3-week history of bilateral eye redness, itching, discomfort, and foreign-body sensation after being treated for presumed allergic conjunctivitis.
• Diagnostic Methods: In vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) were used, followed by metagenomic next-generation sequencing (mNGS) to identify the causative agent.
• Treatment: The patient was treated with chlorhexidine eye drops, levofloxacin eye drops, and ofloxacin eye ointment, with no corticosteroids administered.

Key Findings:

• Microsporidial keratoconjunctivitis was confirmed through metagenomic next-generation sequencing, identifying E. hellem.
• By day 7, symptoms improved significantly, and by day 14, corneal surface and visual acuity were restored.
• Prolonged orthokeratology lens wear and exposure to pet parrots were noted as potential risk factors.

Interpretation:

Microsporidial keratoconjunctivitis can mimic allergic conjunctivitis and may be overlooked in patients with persistent symptoms despite treatment.

Limitations:

• Findings from a single patient may not be generalizable.
• Microscopic confirmation using special staining was not performed.
• Environmental sources were not microbiologically tested.

Conclusion:

Microsporidial infection should be considered in the differential diagnosis of persistent corneal infections in patients with orthokeratology lens wear.

Sources:

• BMC Ophthalmology