Microsporidial epithelial keratitis is an unrecognized cause of superficial punctate keratitis in tropical low- and middle-income countries, especially after recreational or accidental contact with monsoon-related floodwater. In this vignette, a 29-year-old immunocompetent woman presented with sudden unilateral ocular pain, photophobia, and foreign-body sensation. Slit-lamp microscopy showed dense, coarse “stuck-on” punctate epithelial opacities with diffuse fluorescein staining over an otherwise clear stroma, raising suspicion for microsporidial epitheliopathy. Corneal scrapings examined by modified acid-fast staining revealed numerous oval spores with a characteristic waist-band morphology, confirming microsporidial epithelial keratitis. The patient received topical therapy without corticosteroids, achieving rapid symptomatic relief, complete epithelial restitution, and full visual recovery within 1 week. This case underscores microsporidia as a climate-sensitive environmental pathogen of the ocular surface and illustrates how simple, microscopy-based diagnostics can deliver high yield in resource-constrained settings, enabling steroid-sparing, vision-preserving management strategies.
Rebbala et al. (Sat,) studied this question.
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