{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T21:10:05Z","timestamp":1756674605717,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,8,15]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>A young male, a known steroid responder with vernal keratoconjunctivitis, presented with diminished vision, redness and foreign body sensation in his left eye for 20 days. He was on anti-glaucoma medications and tacrolimus 0.03% eye ointment. On examination, greyish-white coarse lesions were observed on his left cornea, along with a few medium to large keratic precipitates (KPs). The corneal scraping demonstrated microsporidial spores, and 2\u2009hourly lubricating eyedrops were initiated. Three days later, the patient remained symptomatic; therefore, a 4\u2009hourly dose of loteprednol 0.5% was initiated, which led to the resolution of KPs. At the 5\u2009weeks follow-up, a few similar coarse lesions were noted on the right cornea. Due to the persistent and recurrent nature of the disease, repeated exposure to a contaminated water source was suspected. Analysis of well water from the patient\u2019s home showed microsporidia through conventional PCR. On refraining from washing his eyes with this water, the patient\u2019s symptoms and epithelial lesions reduced in both eyes over 6\u2009weeks.<\/jats:p>","DOI":"10.1136\/bcr-2024-261066","type":"journal-article","created":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T20:50:14Z","timestamp":1756673414000},"page":"e261066","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges in the management of microsporidial keratoconjunctivitis: recurrent infection and environmental contamination"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4404-9335","authenticated-orcid":false,"given":"Aakash","family":"Sharma","sequence":"first","affiliation":[{"name":"Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7178-1412","authenticated-orcid":false,"given":"Smruti Rekha","family":"Priyadarshini","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srikant Kumar","family":"Sahu","sequence":"additional","affiliation":[{"name":"Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manas Ranjan","family":"Barik","sequence":"additional","affiliation":[{"name":"Department of Microbiology, L.V Prasad Eye Institute, Bhubaneswar, Odisha, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"2025083113500704000_18.8.e261066.1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.44.2.583-585.2006"},{"key":"2025083113500704000_18.8.e261066.2","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.jtos.2021.08.008","article-title":"Past, present, and prospects in microsporidial keratoconjunctivitis- A review","volume":"28","author":"Mohanty","year":"2023","journal-title":"Ocul Surf"},{"key":"2025083113500704000_18.8.e261066.3","doi-asserted-by":"publisher","DOI":"10.1586\/14787210.3.3.419"},{"key":"2025083113500704000_18.8.e261066.4","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.7.4.426"},{"key":"2025083113500704000_18.8.e261066.5","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1097\/ICO.0000000000002297","article-title":"Clinical Profile of Bilateral Microsporidial Keratoconjunctivitis in Healthy Individuals-A Case Series With Long-term Follow-up","volume":"39","author":"Mohanty","year":"2020","journal-title":"Cornea"},{"key":"2025083113500704000_18.8.e261066.6","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.4103\/ijo.IJO_917_17","article-title":"Punctate epithelial keratoconjunctivitis: A microsporidial infestation","volume":"66","author":"Dhakal","year":"2018","journal-title":"Indian J Ophthalmol"},{"key":"2025083113500704000_18.8.e261066.7","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/s40123-020-00243-z","article-title":"A Narrative Review of Microsporidial Infections of the Cornea","volume":"9","author":"Moshirfar","year":"2020","journal-title":"Ophthalmol Ther"},{"key":"2025083113500704000_18.8.e261066.8","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1080\/08820538.2021.1923762","article-title":"A prospective study on the clinical course and proposed morphological classification scheme of microsporidial keratoconjunctivitis","volume":"36","author":"Mohanty","year":"2021","journal-title":"Semin Ophthalmol"},{"key":"2025083113500704000_18.8.e261066.9","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1097\/ICO.0000000000003230","article-title":"Microsporidia-Associated Anterior Uveitis After Keratoconjunctivitis","volume":"42","author":"Mohanty","year":"2023","journal-title":"Cornea"},{"key":"2025083113500704000_18.8.e261066.10","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.4103\/ijo.IJO_1971_20","article-title":"Sequelae of microsporidial keratoconjunctivitis and its management","volume":"69","author":"Mohanty","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"2025083113500704000_18.8.e261066.11","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2019-313988"},{"key":"2025083113500704000_18.8.e261066.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2009.05.004"},{"key":"2025083113500704000_18.8.e261066.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-023-08767-y","article-title":"Microsporidial keratoconjunctivitis - 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