Microsporidial Stromal Keratitis Successfully Treated With Medical Therapy: A Case Report

Purpose: To report a case of stromal microsporidiosis that responded to medical treatment with systemic albendazole and topical chlorhexidine. Methods: A 14-year-old adolescent girl presented with a 3-month history of recurrent redness, pain, and dense anterior stromal corneal infiltrate. Repeated microbiological evaluation helped identify micro-sporidia from the fifth scraping. Initial therapy with fluoroquinolones failed; 0.02% topical chlorhexidine gluconate hourly and 400 mg of oral albendazole twice daily and later 0.5% loteprednol etabonate were given for a total of 12 weeks. Results: There was complete resolution of the infection with corneal scarring with no episodes of recurrence at 1 year of follow-up. The final best-corrected visual acuity was 20/30. Conclusions: The diagnosis of microsporidia can be challenging, and corneal scraping should be repeated several times in cases having a high index of suspicion. Medical therapy can prove successful in selected cases where the infection may be limited to midstroma.