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[Painless acanthamoeba keratitis].

S Roters1, S Aisenbrey, M Severin

  • 1Augenklinik der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50931 Köln, Germany.

Klinische Monatsblatter Fur Augenheilkunde
|September 27, 2001
PubMed
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Acanthamoeba keratitis, a severe eye infection in contact lens wearers, can be mistaken for other conditions. This case highlights a delayed diagnosis despite intensive treatment, necessitating a corneal transplant for vision recovery.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Microbiology

Background:

  • Acanthamoeba keratitis (AK) is a sight-threatening corneal infection often associated with contact lens wear.
  • AK can mimic other forms of keratitis, such as herpetic or fungal infections, particularly when classic symptoms like severe pain are absent.

Observation:

  • A 32-year-old female contact lens wearer presented with unilateral keratitis unresponsive to initial antiviral and corticosteroid treatment.
  • Symptoms included photophobia but notably lacked ocular pain, complicating early diagnosis.
  • Clinical signs included corneal edema, stromal thickening, descemet's striae, and anterior chamber inflammation.

Findings:

  • Corneal scrapings eventually revealed Acanthamoeba (class II) after initial negative viral and bacterial cultures.

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  • Bacterial co-infections (Staphylococci and Enterococci) were identified from corneal scrapings and contact lens solution.
  • Despite aggressive topical and systemic antimicrobial therapy, the keratitis progressed, leading to the need for penetrating keratoplasty.

    • Implications:

    • This case underscores the importance of considering Acanthamoeba keratitis even in the absence of severe pain, especially in contact lens wearers.
    • Delayed diagnosis and treatment can lead to severe visual impairment, necessitating advanced surgical interventions like penetrating keratoplasty.
    • Effective management of Acanthamoeba keratitis requires prompt and accurate diagnosis, often involving specialized microbiological investigations.