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Microsporidial keratoconjunctivitis may mimic allergy

Molecular testing identified Encephalitozoon hellem in a 9-year-old orthokeratology lens wearer after conventional treatment failed.

  • By

  • Andrea Surnit

  • September 16, 2026

  • 4 min

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Clinical Report: Microsporidial keratoconjunctivitis may mimic allergy

Background

Microsporidial keratoconjunctivitis is a rare condition that can mimic allergic conjunctivitis, leading to misdiagnosis and inappropriate treatment. Understanding its clinical presentation and risk factors is crucial for timely diagnosis and management, particularly in patients who wear contact lenses.

Data Highlights

No numerical or trial data provided in the source material.

Key Findings

  • A 9-year-old female patient presented with bilateral eye symptoms initially diagnosed as allergic conjunctivitis.
  • Conventional treatment with antiallergic eye drops was ineffective, prompting further investigation.
  • In vivo confocal microscopy and anterior segment optical coherence tomography revealed significant corneal changes.
  • Metagenomic next-generation sequencing confirmed the diagnosis of microsporidial keratoconjunctivitis caused by Encephalitozoon hellem.
  • The patient showed significant improvement with targeted therapy, including chlorhexidine and levofloxacin eye drops.
  • Prolonged orthokeratology lens wear and exposure to pet parrots were identified as potential risk factors.

Clinical Implications

Clinicians should consider microsporidial keratoconjunctivitis in patients with persistent keratoconjunctivitis that does not respond to standard allergy treatments.

Conclusion

This case highlights the occurrence of bilateral microsporidial keratoconjunctivitis in a pediatric patient wearing orthokeratology lenses.

Related Resources & Content

  1. BMC Ophthalmology, 2026 -- Bilateral microsporidial keratoconjunctivitis in an orthokeratology lens wearer: a case report and literature review
  2. Optometric Management — IDENTIFYING OCULAR ALLERGY
  3. Contact Lens Spectrum — Allergy, Eyedrops and Contact Lenses
  4. Contact Lens Spectrum — Treating Allergies in Contact Lens Wearers
  5. Contact Lens Spectrum — ONLINE PHOTO DIAGNOSIS
  6. IDENTIFYING OCULAR ALLERGY
  7. Allergy, Eyedrops and Contact Lenses
  8. Treating Allergies in Contact Lens Wearers
  9. Microsporidial keratitis: Global epidemiology, pathogen spectrum, and management - PubMed
  10. Bilateral microsporidial keratoconjunctivitis in an orthokeratology lens wearer: a case report and literature review | BMC Ophthalmology | Springer Nature Link
  11. Microsporidial Keratoconjunctivitis Caused by Vittaforma corneae, Sea of Galilee, Israel, 2022–2024 - Volume 31, Number 8—August 2025 - Emerging Infectious Diseases journal - CDC
  12. Characteristics and outcome of microsporidial keratitis | Journal of Ophthalmic Inflammation and Infection | Springer Nature Link

Original Source(s)

Microsporidial keratoconjunctivitis may mimic allergy

  • by Andrea Surnit

  • September 16, 2026

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