Acanthamoeba keratitis: a review of biology, pathophysiology and epidemiology

Acanthamoeba keratitis is an infection caused by a unicellular protozoan of the genus Acanthamoeba that is universally widespread. Until now, most cases were reported in contact lens wearers, although it is also a reality for non-wearers, mostly connected to corneal trauma. There is also a variation in incidence regarding the aetiology of the disease between developed and developing countries.

This work is based on a literature review, and the main goal is to deepen the knowledge about Acanthamoeba keratitis, presenting the main risk factors and focusing on prevention actions for this type of corneal infection since the treatments are not always effective. It targets specialists in visual health to strengthen their knowledge in this area, as well as to allow them to better inform their patients about hygiene care, appropriate measures of disinfection and ways to minimise the risk of infection. At this stage, it is important to highlight the essential role that practitioners play in fitting, monitoring and following-up patients to minimise the danger of infection.

It is well recognised that corneal trauma facilitates invasion by leaving an open door for microorganisms to penetrate the cornea. In addition to trauma, risk factors are mostly associated with patients' behaviours, such as interaction of contact lenses with contaminated water in the shower, swimming pools and beaches, etc., lack of hygiene habits with contact lenses and respective cases, and the use of ineffective disinfecting solutions. The fact that a disinfecting solution is not completely effective against trophozoites and/or cysts, both forms of Acanthamoeba's lifecycle, can cause the infection since one cyst alone leads to the emergence of a whole new population of Acanthamoeba.

It is necessary to reduce the risk of infection and, beyond the need to promote patient education to encourage correct CL hygiene behaviours, it should also be highlighted that there is an urgent need to enhance the efficacy of CL disinfection systems against all strains and both stages of Acanthamoeba through the creation of standardised methods. The ease of purchasing CLs without any supervision must also be considered a concern, and, in the near future, it is also important to develop and implement effective diagnostic methods and treatments for Acanthamoeba keratitis.