BILATERAL ACANTHAMOEBA KERATITIS IN A MINOR SECONDARY TO ORTHOKERATOLOGY LENS WEAR

A 14 year old female presented with a one week history of painful, red, photophobic eyes, which had not improved despite ceasing the contact lens immediately following the onset of symptoms and having used topical antibiotics. She was using rigid gas permeable (RGP) orthokeratology lenses for myopia overnight only. She was not using other contact lenses and followed rigorous contact lens hygiene, with no reported use of tap water.  

The vision at presentation was LogMAR 1.0 (pinhole 0.7) and 1.0 (pinhole 0.8) in the right and left eye, respectively. Slit lamp biomicroscopy showed pseudodendritiform epitheliopathy, radial perineuritis and severe limbitis. A clinical diagnosis of Acanthamoeba keratitis was made, which was subsequently confirmed by PCR taken at presentation. Treatment with hourly G Polyhexamethylene Biguanide (PHMB) 0.02% and G Brolene 0.1% to both eyes was commenced. She was followed up closely in the specialist corneal clinic. The first signs of improvement were noted 2 days after commencing the treatment, however, one week later, her eyes were more inflamed with significant radial perineuritis bilaterally, therefore, the strength of G PHMB was increased to 0.06%. Within another week the patient started to improve symptomatically and epithelial debridement was performed in the right eye to remove any infected surface cells and promote better drop penetration. She continued to improve symptomatically and clinically throughout the next 3 months, at which point G Brolene was stopped and monotherapy with G PHMB 0.06% was continued. Four months after commencement of treatment symptoms were significantly improved with normal corneal appearances and best corrected vision with glasses of LogMAR 0.30 (pinhole 0.12) and 0.24 (pinhole 0.08) in the right and left eye, respectively. She continues to improve on current treatment.