Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct 19;31(1):16-23.
doi: 10.1016/j.joco.2018.09.008. eCollection 2019 Mar.

Acanthamoeba keratitis - Clinical signs, differential diagnosis and treatment

Nóra Szentmáry  1   2 , Loay Daas  1 , Lei Shi  1 , Kornelia Lenke Laurik  1 , Sabine Lepper  1 , Georgia Milioti  1 , Berthold Seitz  1
Affiliations
Review

Acanthamoeba keratitis - Clinical signs, differential diagnosis and treatment

Nóra Szentmáry et al. J Curr Ophthalmol. .

Abstract

Purpose: To summarize actual literature data on clinical signs, differential diagnosis, and treatment of acanthamoeba keratitis.

Methods: Review of literature.

Results: Clinical signs of acanthamoeba keratitis are in early stages grey-dirty epithelium, pseudodendritiformic epitheliopathy, perineuritis, multifocal stromal infiltrates, ring infiltrate and in later stages scleritis, iris atrophy, anterior synechiae, secondary glaucoma, mature cataract, and chorioretinitis. As conservative treatment, we use up to one year triple-topical therapy (polyhexamethylene-biguanide, propamidine-isethionate, neomycin). In therapy resistant cases, surgical treatment options such as corneal cryotherapy, amniotic membrane transplantation, riboflavin-UVA cross-linking, and penetrating keratoplasty are applied.

Conclusion: With early diagnosis and conservative or surgical treatment, acanthamoeba keratitis heals in most cases.

Keywords: Acanthamoeba; Contact lens; Cornea; Keratitis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
"Dirty epithelium" (A), ring infiltrate (arrows) (B), and six months later excimer laser penetrating keratoplasty with interrupted sutures (C), in acanthamoeba keratitis.
Fig. 2
Fig. 2
Incomplete ring infiltrate (arrow) and multifocal stromal infiltrates in acanthamoeba keratitis (A). One week later excimer laser penetrating keratoplasty with interrupted sutures (B).
Fig. 3
Fig. 3
Perineuritis in acanthamoeba keratitis (arrow), 4 weeks after first symptoms (contact lens wearer).
Fig. 4
Fig. 4
Scleritis, corneal ulcer, iris atrophy, persistent mydriasis, and mature cataract in severe acanthamoeba keratitis.
See this image and copyright information in PMC

References

    1. Meltendorf C., Duncker G. Acanthamoeba keratitis. Klin Monatsbl Augenheilkd. 2011;228(3):R29–R43. [Article in German] - PubMed
    1. Szentmáry N., Göbels S., Matoula P., Schirra F., Seitz B. Acanthamoeba keratitis – a rare and often late diagnosed disease. Klin Monbl Augenheilkd. 2012;229(5):521–528. [Article in German] - PubMed
    1. Weekers P.H., Bodelier P.L., Wijen J.P., Vogels G.D. Effects of grazing by the free-living soil amobae Acanthamoeba castallani, Acanthamoeba polyphaga, and Hartmannella vermiformis on various bacteria. Appl Environ Microbiol. 1993;59(7):2317–2319. - PMC - PubMed
    1. Gupta S., Das S.R. Stock cultures of free-living amebas: effct of temperature on viability and pathogenicity. J Parasitol. 1999;85(1):137–139. - PubMed
    1. De Jonckheere J., van de Voorde H. Differences in destruction of cysts of pathogenic and nonpathogenic Naegleria and Acanthamoeba by chlorine. Appl Environ Microbiol. 1976;31(2):294–297. - PMC - PubMed