Microsporidial keratoconjunctivitis in Central India: Epidemiological trends and outcomes over 10 years

To evaluate the epidemiological characteristics, clinical features, and treatment outcomes of microsporidial keratoconjunctivitis (MKC) over a 10-year period at a tertiary eye care center in central India.

This retrospective study analyzed patients diagnosed with MKC between 2015 and 2024. Data from 2005 to 2014 were additionally used to determine hospital-based incidence and prevalence trends. Diagnosis was based on the detection of microsporidial spores in corneal scrapings or characteristic slit-lamp findings. Trends were compared between the two periods (2015-2019 and 2020-2024).

Of 284,211 outpatients seen between 2005 and 2024, 520 (0.2%) were diagnosed with MKC; 393 patients (402 eyes) from 2015 to 2024 were included in the study. The median age was 33 years, with male predominance (64.4%). Most patients were from urban areas (67.9%) and engaged in indoor or sedentary work (81.7%). A significant increase in rural representation and outdoor/manual occupations was observed from 2020 to 2024 ( P = 0.019 and P = 0.018, respectively). Seasonal clustering persisted throughout the rainy season. Minor ocular trauma was reported in 40.7% of cases. The incidence of concurrent diabetes mellitus increased over time. Primary epithelial debridement was performed in 88.1% of patients and was associated with faster epithelial resolution ( P < 0.001). No treatment failures were observed.

MKC is a seasonally patterned infection with evolving epidemiological characteristics. Increased awareness has led to more diagnoses. Increasing rural representation and associated diabetes require further studies. Although typically self-limiting, epithelial debridement may shorten the resolution time and needs to be explored further as a treatment option.