Acanthamoeba epitheliopathy: Atypical presentation of Acanthamoeba keratitis

Abstract

To report clinical features of the epithelial stage of Acanthamoeba keratitis to highlight the impact of an early diagnosis on outcome. A 42-year-old male, with a recurrent history of symptoms and a history of pond water bathing, presented with a linear non-branching epithelial lesion that stained poorly with fluorescein. He was diagnosed with herpes simplex epithelial keratitis and treated with topical acyclovir. However, a ring-like stromal infiltrate developed, and microbiology evaluation revealed Acanthamoeba cysts. Although the disease progressed significantly despite treatment with topical amoebicidal agents, it finally resolved. A 26-year-old male, with an antecedent history of trauma, presented with a ring-like epithelial lesion only, and microbiology evaluation revealed Acanthamoeba cysts. He was treated with topical chlorhexidine 0.02%, and the lesions healed without stromal progression. A delayed diagnosis in the first patient led to a poorer outcome, while an early diagnosis in the second patient led to a better outcome.