A Guide to Clinical Contact Lens Management

Signs, Symptoms, Diagnosis and Management

Academy for Eyecare Excellence™
IN COOPERATION WITH
Centre for Contact Lens Research
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Acanthamoeba infection

Acanthamoeba Infection

Protozoan infection of the cornea

Symptoms

  • Intense pain, generally out of proportion to associated signs
  • Photophobia
  • Long, tortuous course of presentation of varying intensity

Signs

  • Initially presents as a central to paracentral localized haze
  • Presence of cysts or trophozoites within the stroma shown by confocal microscopy
  • Ring infiltrate occurs as the condition advances
  • Poor response to topical therapy

Etiology

  • Acanthamoeba is a ubiquitous free-living protozoan
  • Use of unpreserved solutions, tap water, fresh water or poor hygiene
  • Aggressive infection of the cornea
  • The cyst form of this organism accounts for its resistance to treatment

Prevalence

  • Rare

Differential Diagnosis

Management

  • Early diagnosis and treatment by a corneal specialist is essential.
  • Avoidance is preferable. Avoid unpreserved saline, tap water or other unpreserved solutions, exposure to hot-tubs, and stagnant fresh-water ponds.
  • Replace lens storage case regularly to avoid biofilm buildup; avoid using tap-water to rinse case.
  • Treatment with a combination of anti-amoebic and trophozoicidal drugs [eg, propamidine, neomycin and 0.02% polyhexammethylene-biguanide (PHMB)].
  • To minimize risk, consider DD lenses.
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