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Characteristics and outcome of microsporidial keratitis

Khalid Alburayk1,2, Abdullah Alfawaz3,4, Khalid Tabbara5

  • 1Research Excellence Center in Ophthalmology and Visual Sciences, Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Dr.Khalidba11@gmail.com.

Journal of Ophthalmic Inflammation and Infection
|April 13, 2026
PubMed

Insights

Microsporidial keratitis is often misdiagnosed, delaying treatment. Diffuse epithelial keratitis offers better visual outcomes, while stromal involvement indicates a poorer prognosis for this fungal eye infection.

Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Microsporidia are obligate intracellular fungi, distinct from true fungi, causing various ocular infections.
  • Ocular microsporidial infections can manifest as keratoconjunctivitis, keratitis, scleritis, and endophthalmitis, with rare reporting in ophthalmology.
  • This study focuses on microsporidial keratitis, a condition with diverse clinical presentations.

Purpose of the Study:

  • To evaluate the clinical characteristics of microsporidial keratitis in 26 patients.
  • To assess the visual outcomes associated with different presentations of microsporidial keratitis.
  • To highlight the diagnostic challenges and treatment implications for microsporidial keratitis.

Main Methods:

  • Retrospective review of medical records for 26 immunocompetent patients diagnosed with microsporidial keratitis (2007-2024).
  • Inclusion criteria: confirmed diagnosis via microscopic identification of microsporidia in corneal/conjunctival scrapings.
  • Analysis of clinical symptoms, preliminary diagnoses, treatment history, and visual acuity outcomes.

Main Results:

  • The study included 26 patients (mean age 39, 65% male), with frequent initial misdiagnosis (e.g., bacterial keratitis).
  • Diffuse epithelial keratitis (58%) was the most common presentation, followed by stromal infiltrates and keratoconjunctivitis.
  • Poorer visual outcomes were associated with stromal keratitis and disciform keratitis; diffuse epithelial keratitis showed favorable recovery.

Conclusions:

  • Microsporidial keratitis is frequently misdiagnosed, leading to delayed treatment and impacting visual prognosis.
  • Diffuse epithelial keratitis presentation is linked to better visual outcomes compared to stromal involvement.
  • Emphasizes the critical need for early diagnosis and appropriate management to improve visual recovery in microsporidial keratitis.
Keywords:
CorneaHoneyInfectionKeratitisMicrosporidial

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