optom

1. Presented by :-
RAMJI PANDEY
consultant Optometrist
1

2. M#R: xxxxx
Name: yyyyy
Age: 28
Sex: Female
D/O: 9/2/1987
Occupation: House Wife
2
DEMOGRAPHIC DATA

3. Pain
watering
F.B sensation
Blurring of vision
Chief Complain
3

4. No H/O of ocular and head injury
No H/O of recent oph.consultant @ Bijnor with
Dr. Jay prakash
Past History
No H/O of using glasses
4

5. Family history :- Nil
Surgeries/lasers procedure/ Allergies/
Systemic disease/ Past surgeries / current
treatment:-Nil
current treatment: using some eye drops
5

6. UVA OD OS
Distance :- 20/20 20/40 20/30
Near :- N6 N12
with Hindi chart at 30 cm.
Retinoscopy (dry) :- plano plano
Acceptance Dist. :- DEFER
Near :-
IOP & time 12 Dig(N)
(mm of Hg @2:03pm)
6

7. External examination :- HBT :- Orthotropia
0 0 0 0 0 0
0 0 0 0
0 0 0 0 0 0
Slit Lamp Examination.
7
OD OS
Lid Flat flat
Conjunctiva Quiet Congestion
Cornea Clear As shown
Anterior chamber PACD>1/4CT/Quiet PACD>1/4CT/Quiet
Pupil R/R/R R/R/R
Lens
iop
Clear
12
Clear
DIG(N)

8. .
8

9. FUNDUS EXAMINATION (OU) WNL
C:D = (OU) 0.3 : 1 HNRR
DIAGNOSIS
(OD):-Emmetropia
(OS):-Microspordiosis keratitis
Treatment Adv:-
E/D moxixip Q2H
E/D R.L Q2H
Tablet Diclomol TID
9

10. Subject :- patient fells same as previous
UVA :-(OD):- 20/20
(OS):- 20/30 20/25p
SLE (OU) :- Ant. Seg (OD): WNL
(OS)
Cornea: as shown
Rest all ant seg: WNL
Follow op # 10 day
10
CRX
As adviced

11. .
IMP advice
Doing well CST
e/d Flarex QID

12. Microspordial keratitis
This infection of the cornea which is form an organism
known's as microspordia. Where 75% involment of the epithelia
and J25% of stromal layer
oseph J, Vemuganti GK, Sharma S. Microsporidia: Emerging Ocular Pathogens. Indian Journal of Medical Microbiology.
2005;23(2):80-91.. 12

13. Microspordia
 Species of protozoa
 Recent studies : related to kingdom fungi
 size 3.5*2 micron
 spore forming
 obligate intracellular parasite
 First recognized - 1857
 First reported – 1973 in India
13

14. The infectious pathogen causes
 ocular infection
 sinus
 hepatitis
 nephritis
 muscular disease
14

15. ocular microsporidiosis
 Kerato conjunctivitis
 kerato uveitis
 microspordial keratitis
15

16. .
16

17. Risk factors
 Dirty water
 Trauma
 Insects bites
 Contacts with domestic animal
 Immunodeficiency immunocompetent
 Exposure of hot spring season
 Topical steroid
 contact lens wearer
Vemuganti G, Garg P, Sharma S, Joseph J, Gopinathan U, Singh S. Is Microsporidial Keratitis an emerging cause of stromal
keratitis?- a case series study.BMC Ophthalmology.2005:5:19.
17

18. Systemic disease
 Immune suppressions disease
e.g. AIDS
Typhoid
Diabetes
18

19.  Currently, most cases of human Microsporidiosis are
associated with HIV infection.
* Weber R, Bryan RT. Microsporidial infections in immunodeficient and immunocompetent patients. Clin Infect
Dis.1994;19:517-21.
But recently Microsporidia has been reported to cause
multifocal coarse superficial punctate keratitis in
immunocompetent individuals.
* Joseph J, Sridhar MS, Murthy S, Sharma S. Clinical and microbiological profile of microsporidial keratoconjunctivitis
in Southern India.Ophthalmology.2006;113:531-7.
19

20. Epidemiology
 90 % UNILATERAL
 RACE: No predilection
 SEX: No predilection
 AGE: No predilection
 SEASON: Monsoon
1. Quek DT, Pan JCH, Krishnan PU, Zhao PS, Teoh SCB. Microsporidial Keratoconjunctivitis in the Trpics: A Case Series.
Open Ophthalmol J.2011;5:42-47.
2. Reddy AK, Balne PK, Garg P, Krishnaiah S. Is Microsporidial Keratitis a seasonal infection in India? Clin Microbiol and Inf.
2011 Jul; 17(7):1114-6
20

21. Clinical findings
 white dots on the cornea
 satellite opacities
 multiple superficial epithelial
infiltrate
 oval in shape opacities
 corneal sensation are normal
 fluorescence statining
21

22. 22

23. Transmission
 Human to Human
 Animal to Human
 Water transmission
 Inhalation
23

24. Ocular Symptoms
 Pain
 Watering
 Foreign body sensation
 Discharge
 Blurring of vision
24

25. Physical symptoms
 Watering from nose
 Headache
 Recurrent of fever
 Diarrhoea ( loose, watery , nonbloody)
 Muscular pain , muscles weakness
 Infection of the brain
 Weber R, Bryan RT. Microsporidial infections in immunodeficient and immunocompetent patients. Clin Infect
Dis.1994;19:517-21.
25

26. Investigation
26
Systemic investigation
1. urine
2. Intestinal tract
3. Nasal discharge

27. 4. AIDS
Ocular Investigation
1.corneal scraping
 Gram stain
 KOH Stain
 Acid Fast Stain 27

28. 28

29. Treatment
General treatment
 personal hygiene
 Change the environment
 Maintains balance diet
 Proper hygiene of contact lens
29

30. Medical therapy
 Antibiotics
 Anti fungal
 Anthelmintics
 Antiprotozoals
 Immunomodulatory
 Lubricating
 Treatment of the associated disease
30

31.  Treatment of Microsporidial Keratitis with Topical
Voriconazole Monotherapy
1. Khandelwal S, Woodward M, Hall T, Grossniklaus H, Stulting R. Treatment of Microsporidia Keratitis With Topical
Voriconazole Monotherapy. Arch Ophthalmol.2011 Apr; 129(4):509-510
31