Raavi Gupta1, Matthew Gorski2, Triona Henderson1, Douglas Lazzaro2, M A Haseeb3. 1. Department of Pathology, Downstate Medical Center, State University of New York, and Kings County Hospital Center, Brooklyn, New York, USA. 2. Department of Ophthalmology, Downstate Medical Center, State University of New York, and Kings County Hospital Center, Brooklyn, New York, USA. 3. Department of Pathology, Downstate Medical Center, State University of New York, and Kings County Hospital Center, Brooklyn, New York, USA haseeb.siddiqi@downstate.edu.
Abstract
PURPOSE: To report the features and clinical course of Acanthamoeba keratitis in a cosmetic contact lens wearer. CASE REPORT: A 29-year-old man sought medical attention for severe ocular pain, blurry vision, photophobia, and a foreign body sensation in the left eye for the past 3-4 days. He had been wearing a single sapphire cosmetic soft contact lens for 1-2 months. The left upper eyelid was edematous and the conjunctiva was hyperemic; the best corrected distance visual acuity was 20/400. A slit lamp examination revealed circular and perineural linear stromal opacities and diffuse keratic precipitates. A clinical diagnosis of herpes simplex keratitis was made and the patient was started on antiviral therapy. After initial improvement, the patient returned with worsening pain and vision; the corneal lesions had exacerbated. Unresponsiveness to antiviral therapy prompted examination of corneal scrapings, which revealed Acanthamoeba developmental forms. Antimicrobial therapy was prescribed resulting in relief of symptoms despite corneal opacities and poor vision. CONCLUSION: This case illustrates the importance of considering Acanthamoeba keratitis in contact lens wearers at presentation, particularly in those with symptomatic keratitis unresponsive to antiviral and antifungal therapy.
PURPOSE: To report the features and clinical course of Acanthamoeba keratitis in a cosmetic contact lens wearer. CASE REPORT: A 29-year-old man sought medical attention for severe ocular pain, blurry vision, photophobia, and a foreign body sensation in the left eye for the past 3-4 days. He had been wearing a single sapphire cosmetic soft contact lens for 1-2 months. The left upper eyelid was edematous and the conjunctiva was hyperemic; the best corrected distance visual acuity was 20/400. A slit lamp examination revealed circular and perineural linear stromal opacities and diffuse keratic precipitates. A clinical diagnosis of herpes simplex keratitis was made and the patient was started on antiviral therapy. After initial improvement, the patient returned with worsening pain and vision; the corneal lesions had exacerbated. Unresponsiveness to antiviral therapy prompted examination of corneal scrapings, which revealed Acanthamoeba developmental forms. Antimicrobial therapy was prescribed resulting in relief of symptoms despite corneal opacities and poor vision. CONCLUSION: This case illustrates the importance of considering Acanthamoeba keratitis in contact lens wearers at presentation, particularly in those with symptomatic keratitis unresponsive to antiviral and antifungal therapy.