A 28-year-old female with a history of
contact lens wear presented with a 1 week history of
pain and
photophobia in her left eye. In vivo confocal microscopy (IVCM) and corneal scrape confirmed the diagnosis of
Acanthamoeba keratitis (AK) which was treated with intensive topical
propamidine isethionate (0.1%) and
chlorhexidine (0.02%) with tapering dosage over 11 months. Five years after complete resolution of AK and cessation of all
contact lens wear, the subject presented to her optometrist with a history of ocular discomfort and mild
photophobia. Without further investigation she was prescribed topical
corticosteroids. Three weeks later she presented with
pain and
reduced vision in the left eye.
Slit-lamp examination revealed focal, inferior corneal stromal
edema. IVCM confirmed widespread Acanthamoeba
cysts. Treatment with topical
polyhexamethylene biguanide (PHMB) 0.02% and
propamidine isethionate 0.1% resulted in resolution of the AK. Despite an initially mild AK, this subject presumably retained viable Acanthamoeba
cysts in her cornea 5 years after the initial episode. This report highlights the importance of caution when using
corticosteroids in patients with a previous history of AK, even in the relatively distant past. Patients with AK should be warned regarding the risks of recurrence following presumed resolution.