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A 28-year-old patient presented to us with multifocal coarse raised epithelial lesions in the left eye associated with pain watering redness and blurred vision with a visual acuity of 20/40 in the left eye. The patient had been managed elsewhere with a course of topical moxifloxacin eye-drops four times a day and topical steroids (prednisolone acetate) 1% three times a day for 2 weeks without any resolution, which was stopped 2 days ago prior to presentation at our centre. Gram stain was negative for bacteria as well as microsporidial spores. 10% KOH was negative for fungal hyphae. Based on strong clinical signs of corneal microsporidiosis, in spite of the negative microbiology smear, the patient was started on voriconazole eye-drops five times a day. The lesions started resolving in 5 days and completely healed after 17 days of therapy. No relevant history pertaining to exposure of contaminated water, swimming or history of trauma could be elicited.

Importance of clinical signs leading to the diagnosis in a case of microbiological smear negative ocular microsporidiosis