Microsporidial keratoconjunctivitis may mimic allergy
Molecular testing identified Encephalitozoon hellem in a 9-year-old orthokeratology lens wearer after conventional treatment failed.
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By
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Andrea Surnit
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September 16, 2026
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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.
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