4. No H/O of ocular and head injury
No H/O of recent oph.consultant @ Bijnor with
Dr. Jay prakash
Past History
No H/O of using glasses
4
5. Family history :- Nil
Surgeries/lasers procedure/ Allergies/
Systemic disease/ Past surgeries / current
treatment:-Nil
current treatment: using some eye drops
5
6. UVA OD OS
Distance :- 20/20 20/40 20/30
Near :- N6 N12
with Hindi chart at 30 cm.
Retinoscopy (dry) :- plano plano
Acceptance Dist. :- DEFER
Near :-
IOP & time 12 Dig(N)
(mm of Hg @2:03pm)
6
10. Subject :- patient fells same as previous
UVA :-(OD):- 20/20
(OS):- 20/30 20/25p
SLE (OU) :- Ant. Seg (OD): WNL
(OS)
Cornea: as shown
Rest all ant seg: WNL
Follow op # 10 day
10
CRX
As adviced
12. Microspordial keratitis
This infection of the cornea which is form an organism
known's as microspordia. Where 75% involment of the epithelia
and J25% of stromal layer
oseph J, Vemuganti GK, Sharma S. Microsporidia: Emerging Ocular Pathogens. Indian Journal of Medical Microbiology.
2005;23(2):80-91.. 12
13. Microspordia
Species of protozoa
Recent studies : related to kingdom fungi
size 3.5*2 micron
spore forming
obligate intracellular parasite
First recognized - 1857
First reported – 1973 in India
13
17. Risk factors
Dirty water
Trauma
Insects bites
Contacts with domestic animal
Immunodeficiency immunocompetent
Exposure of hot spring season
Topical steroid
contact lens wearer
Vemuganti G, Garg P, Sharma S, Joseph J, Gopinathan U, Singh S. Is Microsporidial Keratitis an emerging cause of stromal
keratitis?- a case series study.BMC Ophthalmology.2005:5:19.
17
19. Currently, most cases of human Microsporidiosis are
associated with HIV infection.
* Weber R, Bryan RT. Microsporidial infections in immunodeficient and immunocompetent patients. Clin Infect
Dis.1994;19:517-21.
But recently Microsporidia has been reported to cause
multifocal coarse superficial punctate keratitis in
immunocompetent individuals.
* Joseph J, Sridhar MS, Murthy S, Sharma S. Clinical and microbiological profile of microsporidial keratoconjunctivitis
in Southern India.Ophthalmology.2006;113:531-7.
19
20. Epidemiology
90 % UNILATERAL
RACE: No predilection
SEX: No predilection
AGE: No predilection
SEASON: Monsoon
1. Quek DT, Pan JCH, Krishnan PU, Zhao PS, Teoh SCB. Microsporidial Keratoconjunctivitis in the Trpics: A Case Series.
Open Ophthalmol J.2011;5:42-47.
2. Reddy AK, Balne PK, Garg P, Krishnaiah S. Is Microsporidial Keratitis a seasonal infection in India? Clin Microbiol and Inf.
2011 Jul; 17(7):1114-6
20
21. Clinical findings
white dots on the cornea
satellite opacities
multiple superficial epithelial
infiltrate
oval in shape opacities
corneal sensation are normal
fluorescence statining
21
30. Medical therapy
Antibiotics
Anti fungal
Anthelmintics
Antiprotozoals
Immunomodulatory
Lubricating
Treatment of the associated disease
30
31. Treatment of Microsporidial Keratitis with Topical
Voriconazole Monotherapy
1. Khandelwal S, Woodward M, Hall T, Grossniklaus H, Stulting R. Treatment of Microsporidia Keratitis With Topical
Voriconazole Monotherapy. Arch Ophthalmol.2011 Apr; 129(4):509-510
31