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
Clinical Scorecard: Microsporidial keratoconjunctivitis may mimic allergy
At a Glance
Category Detail
Condition Microsporidial keratoconjunctivitis Key Mechanisms Infection by Enterocytozoon hellem, potentially linked to orthokeratology lens wear and exposure to pet parrots. Target Population Immunocompetent pediatric patients, particularly those wearing orthokeratology lenses. Care Setting Ophthalmology clinics
Key Highlights
Bilateral microsporidial keratoconjunctivitis diagnosed in a 9-year-old female. Initial misdiagnosis as allergic conjunctivitis with no response to antiallergic treatment. Diagnosis confirmed via metagenomic next-generation sequencing (mNGS). Treatment included chlorhexidine and levofloxacin eye drops, leading to symptom resolution. Consideration of microsporidial infection in persistent keratoconjunctivitis cases. Guideline-Based Recommendations
Diagnosis
Consider corneal scraping or molecular testing to confirm microsporidial infection. Management
Use targeted therapy based on diagnostic confirmation. Monitoring & Follow-up
Follow-up for symptom resolution and visual acuity improvement. Risks
Prolonged orthokeratology lens wear and exposure to pet parrots may increase infection risk. Patient & Prescribing Data
Immunocompetent children wearing orthokeratology lenses.
Chlorhexidine and levofloxacin eye drops were effective in resolving symptoms.
Clinical Best Practices
Consider microsporidial keratoconjunctivitis in differential diagnosis for persistent keratoconjunctivitis. Utilize advanced imaging techniques like AS-OCT and IVCM for diagnostic support. Related Resources & Content
