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Acanthamoeba sclerokeratitis. Determining diagnostic criteria
Archives of Ophthalmology (Chicago, Ill. : 1960)
|September 1, 1986
Summary
Acanthamoeba infection can cause severe eye inflammation, including scleritis, particularly in contact lens wearers. Early diagnosis is crucial and relies on specific historical and clinical criteria for effective Acanthamoeba keratitis management.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Acanthamoeba infections are increasingly recognized, particularly affecting the cornea.
- Scleritis, inflammation of the eye's white outer layer, is a significant but often overlooked component of Acanthamoeba keratitis.
Observation:
- Two cases of Acanthamoeba sclerokeratitis in contact lens wearers highlighted the central role of scleritis (anterior and posterior).
- Posterior scleritis has not been previously reported in Acanthamoeba infections.
- Diagnosis is frequently missed due to undefined historical and clinical criteria.
Findings:
- A review of 26 cases and the current cases suggests scleritis is more common than previously acknowledged.
- Key diagnostic criteria include contact lens wear, minor corneal trauma, exposure to contaminated water/soil, severe pain, ring-shaped stromal keratitis, uveitis, epithelial erosion, scleritis, negative bacterial cultures, chronicity, and poor response to antimicrobials.
Implications:
- Establishing clear diagnostic criteria can lead to earlier and more accurate identification of Acanthamoeba infections.
- Recognizing scleritis as a common feature, including posterior scleritis, is vital for appropriate patient management.
- Improved diagnostic approaches are needed to prevent vision loss from this potentially blinding infection.