Cornea - I Free Papers - aioseducation

Cornea Free Papers
Corneal scraping was performed with Bard-Parker no. 15 blade. Examination
in normal saline wet mount preparation demonstrated trophozoites. The
trophozoites showed rapid movement suggestive of flagellated protozoan. The
material was also seen in 10% KOH mount. There were no hyphae or other
elements resembling fungal structures. The material was inoculated on nonnutrient
agar overlaid with E. coli for free-living amoebas. No growth was
observed till two weeks of incubation.
Patient was put on topical neomycin, polymyxin B and bacitracin eye drops
one hourly; clotrimazole 1% eye drops two hourly and atropine 1% eye drop
twice a day.
The corneal condition improved within one week of therapy. The
frequency of administration of drops was gradually tapered. At four
weeks follow-up the cornea was clear and without any evidence of sub
epithelial opacification.
DISCUSSION
Cornea infection in this case probably resulted from direct contact with
contaminated water. The rapid motility of trophozoites was suggestive of
flagellated protozoan like Giardia or Chylomastix. The rapid motility and
sterile culture excluded protozoa like Acanthamoeba or Naegleria. Typical
motility of trophozoites on fresh examination is the key for diagnosis. 5 Saline
preparation of corneal scraping should be done to exclude motile parasites.
We took opinion from two experts by showing them video of trophozoites.
Both agreed with diagnosis of a flagellated parasite especially Chylomastix.
To best of our knowledge this is the first report in literature (Medline search)
on keratitis by an unusual flagellated parasite.
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