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A 31-year-old man from Telangana, IT professional by occupation presented with severe eye pain, blurred vision, redness of the right eye and photophobia for the past five days. He is a contact lens wearer and went swimming while wearing his lenses. Slit lamp findings showed corneal epithelial defect, ring-shaped infiltrate in the right eye with cloudy cornea and conjunctival injection. Corneal scraping was sent for microscopy.
- What is the diagnosis?
- What is the mode of acquisition?
- What is the treatment of choice?
Case answer – Posted on: 17-Oct-2024
- What is the diagnosis?
Acanthamoeba keratitis; the cyst measures between 10-25 µm in size, has a distinctive double-walled structure with an outer wrinkled wall, known as the ectocyst, and inner polyhedral shaped wall called the endocyst. - What is the mode of acquisition?
Acanthamoeba is acquired through trauma to the eye usually from a foreign body or scratch, as well as through contact lens use (contaminated lens solutions or cleaning lenses with tap water or exposure to contaminated water). - What is the treatment of choice?
Topical agents like chlorhexidine or polyhexamethylene biguanide (PHMB) 0.02%, eyedrops with and without propamidine 0.1% applied every hour. Oral NSAIDs are recommended for pain relief. The patient should be advised to discontinue contact lens use and avoid exposure to recreational water (swimming pools, hot tubs). Close follow-up needed to monitor response to treatment, as Acanthamoeba keratitis may require prolonged therapy for weeks to months. If medical management fails or if infection progresses, surgical intervention such as keratoplasty may be considered.
References:
- Garg P, Kalra P, Joseph J. Non-contact lens related Acanthamoeba keratitis. Indian J Ophthalmol. 2017 Nov;65(11):1079-1086.
- Joseph J, Chaurasia S, Sharma S. Case Report: Corneal Coinfection with Fungus and Amoeba: Report of Two Patients and Literature Review. The American Journal of Tropical Medicine and Hygiene. 2018;99(3):805-808.