Various Acanthamoeba species can cause chronic and progressively destructive keratitis Interstitial Keratitis Interstitial keratitis is chronic, nonulcerative inflammation of the mid-stroma (the middle layers of the cornea) that is sometimes associated with uveitis. The cause is usually infectious.... read more in normal hosts. The main risk factor (85% of cases) is contact lens use, particularly if lenses are worn while swimming or if unsterile lens cleaning solution is used. Some infections follow corneal abrasion.
Acanthamoeba are present worldwide in water, soil, sewage, and dust. They can also be present in tap water, showers, hot tubs, and air conditioning units. The life cycle of Acanthamoeba involves only 2 stages: cysts and trophozoites (the infective form). The trophozoites form double-walled cysts, which resist eradication. Both forms can enter the body through various means (eg, eyes, nasal mucous membranes, broken skin). When Acanthamoeba enter the eye, they can cause severe keratitis. In infected patients, both cysts and trophozoites may be found in the cornea.
Symptoms and Signs of Amebic Keratitis
Lesions in patients with amebic keratitis are typically very painful and produce a foreign body sensation, redness, photosensitivity, excess tearing, and diminished vision, but typically not systemic symptoms. Initially, lesions may have a dendriform appearance resembling herpes simplex keratitis Herpes Simplex Keratitis Herpes simplex keratitis is corneal infection with herpes simplex virus. It may involve the iris. Symptoms and signs include foreign body sensation, lacrimation, photophobia, and conjunctival... read more . Later, there are patchy stromal infiltrates and sometimes a characteristic ring-shaped lesion. Anterior uveitis is usually also present.
Diagnosis of Amebic Keratitis
Examination and culture of corneal scrapings
Consultation with an ophthalmologist is important for diagnosis and treatment of amebic keratitis.
Diagnosis of amebic keratitis is confirmed by examination of Giemsa- or trichrome-stained corneal scrapings and by culture on special media. Viral culture is done if herpes simplex is considered.
Treatment of Amebic Keratitis
Topical chlorhexidine, polyhexamethylene biguanide, or both
Early, superficial amebic keratitis responds better to treatment.
Epithelial lesions are debrided, and intensive drug therapy is applied. The initial choice is
Topical chlorhexidine 0.02%
Topical polyhexamethylene biguanide 0.02%
For the first 3 days, drugs are given every 1 to 2 hours. Other topical drugs used as adjunct therapy include the diamidines propamidine (0.1%) or hexamidine (0.1%).
Early recognition and treatment have eliminated the need for therapeutic keratoplasty in most instances, but keratoplasty remains an option when pharmacologic therapy fails. Intensive treatment is required for the first month; it is tapered per clinical response but continued for 6 to 12 months. Recurrence is common if treatment is stopped prematurely.
Prevention of Amebic Keratitis
To prevent amebic keratitis, contact lenses should be cleaned and stored following the recommendations of eye care providers and manufacturers. Hands should be washed thoroughly before handling them. Solution should be kept fresh, not reused, and not topped off; tap water should never be used. Nonsterile homemade contact lens solutions should not be used. Wearing contact lenses while swimming or showering should be avoided.
Various Acanthamoeba species can cause chronic and progressively destructive keratitis in otherwise healthy hosts, mainly in contact lens users.
Consult with an ophthalmologist about management.
Diagnose by examining Giemsa- or trichrome-stained corneal scrapings or by culturing the sample using special media.
Herpes simplex keratitis can cause similar lesions; if it seems a possible diagnosis, do viral culture.
Debride corneal lesions, and treat with topical chlorhexidine, polyhexamethylene biguanide, or both, plus possibly a diamidine for 6 to12 months.