Microsporidial Keratoconjunctivitis

We report microsporidial keratoconjunctivitis in a young male exposed to muddy water while repairing a water distribution pipe successfully treated with topical voriconazole. A 22-year-old healthy male who is a plumber by profession presented with chief complaints of sudden pain, redness, watering, and decreased vision in his left eye. These symptoms occurred two days after a water distribution pipe that he was repairing burst and the water came in contact with his eye. A slit-lamp examination of his left eye revealed multifocal, coarse, white corneal epithelial infiltrates [Figure 1(a)]; he had a visual acuity of 20/200. In vivo confocal microscopy revealed epithelial rosettes and intraepithelial pinpoint hyper-reflective spores [Figure 1(b)]. Staining with potassium hydroxide–calcofluor white revealed oval bluish fluorescent bodies [Figure 1(c)]. Anterior segment optical coherence tomography demonstrated stuck-on-plaques on the surface of the cornea [Figure 1(d)]. Slitlamp biomicroscopy revealed a clear cornea after hourly treatment with voriconazole drops. After one week of treatment, the cornea was clear and visual acuity improved to 20/20 [Figure 1(e)].