Photo Essay Microsporidial Keratoconjunctivitis R Balamurugan, MS; Parul Chawla Gupta, MS; Surya Prakash Sharma, MS; Neeti Rana, MBBS Jagat Ram, MS, FAMS Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India ORCID: R Balamurugan: https://orcid.org/0000-0003-3363-1135 Jagat Ram: https://orcid.org/0000-0001-6251-2800 J Ophthalmic Vis Res 2020; 15 (2): 259–260 PRESENTATION We report microsporidial keratoconjunctivitis in a young male exposed to muddy water while repair- ing a water distribution pipe successfully treated with topical voriconazole. DISCUSSION 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 Correspondence to: Jagat Ram, MS, FAMS. Department of Ophthalmol- ogy, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh 160012, India. E-mail: drjagatram@gmail.com Received: 13-09-2019 Accepted: 05-12-2019 Access this article online Website: https://knepublishing.com/index.php/JOVR DOI: 10.18502/jovr.v15i2.6746 on the surface of the cornea [Figure 1(d)]. Slit- lamp 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)]. Microsporidial keratoconjunctivitis occurs primarily in males and is usually unilateral. It has recently been observed to cause multifocal coarse punctate epithelial keratitis in immunocompromised individuals, In addition to the use of contact lenses, another risk factor for microsporidial keratoconjunctivitis that may be less recognized because of the lack of awareness among ophthalmologists is the exposure to muddy water[2, 3] predominantly observed during the rainy season[4] in developing countries. Financial Support and Sponsorship None. Conflicts of Interest There are no conflicts of interest. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. How to cite this article: Balamurugan R, Gupta PC, Sharma SP, Rana N, Ram J. Microsporidial Keratoconjunctivitis. J Ophthalmic Vis Res 2020;15:259– 260. © 2020 JOURNAL OF OPHTHALMIC AND VISION RESEARCH | PUBLISHED BY KNOWLEDGE E 259 http://crossmark.crossref.org/dialog/?doi=10.18502/jovr.v15i2.6746&domain=pdf&date_stamp=2019-07-17 https://knepublishing.com/index.php/JOVR Photo Essay; Balamurugan et al Figure 1. (a) Multifocal, coarse, white corneal epithelial infiltrates (b) In vivo confocal microscopy showing epithelial rosettes and intraepithelial pin–point hyperreflective spores (c) Combined potassium hydroxide-calcofluor white staining showing oval bluish fluorescent bodies (d) Anterior segment optical coherence tomography demonstrating stuck on plaques on the corneal surface (e) Slit lamp biomicroscopy showing clear cornea after treatment. REFERENCES 1. Chan CM, Theng JT, Li L, Tan DT. Microsporidial keratocon- junctivitis in healthy individuals: a case series. Ophthalmol- ogy 2003;110:1420–1425. 2. Joseph J, Sridhar MS, Murthy S, Sharma S. Clinical and microbiological profile of microsporidial keratoconjunctivitis in southern India. Ophthalmology 2006;113:531–537. 3. Kwok AKH, Tong JMK, Tang BSF, Poon RWS, Li WWT, Yuen KY. Outbreak of microsporidial keratoconjunctivitis with rugby sport due to soil exposure. Eye 2013;27:747– 754. 4. Sharma S, Das S, Joseph J, Vemuganti GK, Murthy S. Microsporidial keratitis: Need for increased awareness. Surv Ophthalmol 2011;56:1–22. 260 JOURNAL OF OPHTHALMIC AND VISION RESEARCH VOLUME 15, ISSUE 2, APRIL-JUNE 2020