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| CASE REPORT |
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| Year : 1993 | Volume
: 41
| Issue : 4 | Page : 187-188 |
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Acanthamoeba keratitis in hard contact lens wearer
M Srinivasan, Prabjot Channa, CV Gopala Raju, C George
Aravind Eye Hospital, Madurai, India
Correspondence Address:
M Srinivasan
Cornea Service, Aravind Eye Hospital, Madurai 625 020
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 8005652 
How to cite this article:
Srinivasan M, Channa P, Gopala Raju C V, George C. Acanthamoeba keratitis in hard contact lens wearer. Indian J Ophthalmol 1993;41:187-8 |
Acanthamoeba is an ubiquitous free-living amoeba and is responsible for increasing incidence of keratitis, mostly in contact lens wearers. Almost all the cases reported in western literature were seen in contact lens patients. In India, the first case of Acanthamoeba keratitis was reported by us [1] in a noncontact lens wearer. Subsequently we reported 9 culture proven cases in non-contact lens wearers. [2],[3] In most of the cases trauma with mud, soil, sea water, or vegetable matter was the contributing factor? We report, what is to the best of our knowledge, the first case of Acanthamoeba keratitis in a hard contact lens wearer.
| Case report | |  |
An otherwise healthy, non-diabetic 40-year-old women with a two-year history of hard contact lens wear in her left eye for unilateral myopia, presented on August 29, 1991 with complaints of pain, defective vision, redness, watering in the left eye of fifteen days duration. She was treated elsewhere with topical steroids for two weeks. The contacts lens was used on a dailywear schedule of 10 to 12 hours per day.Her lens care regimen was poor, using mostly tap water and rarely with contact lens care solution.
On examination, the visual acuity in the right eye was 6/6 and in the left eye was 1/60. On slit-lamp biomicroscopic examination, there was minimal lid oedema without chemosis or discharge. There was severe injection of bulbar conjunctiva. The cornea had curvilinear epithelial defect close to the inferior limbus, more pronounced in the infero nasal quadrant associated with diffuse woolly, dirty white infiltration measuring about 7 mm vertically and 5 mm horizontally. An incomplete ring infiltration progressing superiorly above the pupil [Figure - 1] was indicative of Acanthamoeba keratitis. There was no vascularisation. The right eye was normal. Fundus examination in the left eye was not possible due to hazy media and intraocular pressure was normal by digital method.
After application of 4% lidocaine, the corneal infiltration was scraped well under magnification using a sterile Grieshaber blade and spread over two clean slides. Additional specimens were inoculated directly onto sheep blood agar, thioglycolate broth, Sabouraud's dextrose agar, and non nutrient agar with an overlay of E.coli. Ten percent potassium hydroxide wet mount at 450 x magnification revealed polygonal double-walled cyst, and similar cysts were also noticed in Giemsa stain. On the fourth day following inoculation Acanthamoeba was grown in nonnutrient agar. The inoculum from the contact lens and the container was sterile.
The treatment was initiated on the first day itself with topical Neosporin drops and 2% ketaconazole prepared by dissolving 200 mg tablet of ketaconazole in 10 ml of 2% methyl cellulose (Moisol). The patient was instructed to apply each drug on hourly basis for the first 48 hours and every two hours during waking hours from the third day onwards. One percent cyclopentolate was applied twice a day and analgesics were recommended to relieve pain. The patient was treated as an outpatient. Slit-lamp biomicroscopic examination was made every 3 or 4 days for the first two weeks and every week for another 4 weeks. At the end of 6-week treatment the ulcer healed with scarring [Figure - 2]. Superficial and deep vessels were seen inferiorly and at 1 o'clock position. Fluorescein staining revealed no epithelial defect or toxicity of topical medications. She was last seen on October 14, 1991 and was still on Neosporin drops thrice a day, with 2% ketaconazole being discontinued on October 8, 1991.
| Discussion | | |
Association of Acanthamoeba keratitis in soft contact lens wearers has been frequently reported in European and American literature. [4] To our knowledge, the same has not been reported in India so far. We consider this report more significant since the keratitis was associated with hard contact lens wear. The occurrence of contact lens-associated keratitis has been reported by several investigators . [4] Epithelial defects produced by contact lens wear enhance the adherence of cysts of Acanthamoeba and thereby facilitates infection. Sterilisation of contact lens is not possible with present methods. The best method of disinfection would be to heat sterilize the lens or to treat it with 3% hydrogen peroxide for 6 hours. However, the cysts may survive despite these methods of disinfection. Due to increased incidence of this devastating corneal infection, contact lens wearers should be suitably warned about this potential vision-threatening infective keratitis, which unfortunately has no specific treatment.
| References | | |
| 1. | Sharma S, Srinivasan M, and George C. Keratitis due to Acanthamoeba castellani. Afro Asian J Ophthalmology. 7:104 -106, 1988. 
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| 2. | Sharma S, Srinivasan M, and George C. Diagnosis of Acanthamoeba keratitis. A report of four cases and review of literature. Ind J Ophthalmol. 38:50-56, 1990.
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| 3. | Sharma S, Srinivasan M, and George C. Acanthamoeba keratitis in non-contact lens wearers. Arch Ophthalmol. 108:676-678, 1990.
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| 4. | Moore MB, McCulley JP, Luckenbach M, et al. Acantlwmoeba keratitis associated with soft contact lenses. Am J Ophthalmol. 100:396-403, 1985. |
[Figure - 1], [Figure - 2]
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