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We report a case of microsporidial stromal keratitis successfully treated with topical voriconazole and oral itraconazole. A 30-year-old Hispanic male construction worker who wears contacts lenses presented with left eye erythematous, epiphora, and mild pain increasing over few days after failing previous antibiotics treatment. His best corrected visual acuity in the left eye was count fingers at three feet, and the slit lamp examination showed 3+ conjunctival injection, a circular central corneal ulcer 3.2 mm in diameter, stromal thinning, and an anterior chamber with white cells, flair, and 0.1 mm hypopyon. A cornea punch biopsy identified microsporidial organisms with some features suggestive of Vittaforma corneae. After treatment with topical voriconazole and oral itraconazole for eight weeks, the patient had complete resolution with no recurrence for over 12 months of follow-up. To our knowledge, this is the first reported case of successful treatment of microsporidial stromal keratitis with antifungals.

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Primary ocular lymphomas are typically confined to either the eye or the orbit. Rarely, in immune-competent patients, lymphomas affect both the eye and the orbit simultaneously. Mucosa-associated lymphoid tissue (MALT) lymphomas are the most common ocular lymphomas. They usually present primarily in the orbit but sometimes can present primarily in intraocular tissue. MALT lymphomas that occur initially in the uvea can sometimes spread to the adjacent orbit. We report a case of progressively enlarging MALT lymphoma in a 62-year-old immune-competent patient causing a severe mass effect in the orbit and simultaneously presenting with intraocular involvement. There was radiographic evidence of lymphoma confined to the orbit with intraocular involvement. The simultaneous presentation makes it difficult to determine if the lymphoma initially presented in the orbit or intraocular tissue, although the orbital component was more impressive. The case also includes a literature review of simultaneous orbital and intraocular MALT lymphomas. The patient responded to systemic chemotherapy with regression in size of the lymphoma, relief of the mass effect seen in the orbit, and the regression of the intraocular involvement.

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